Politicians debating mental health laws for England and Wales could learn from new compulsory treatment system in Scotland

As politicians prepare to debate new laws on compulsory treatment for mental health patients in England and Wales, a King's Fund report today points to useful lessons from Scotland's new system for ensuring such patients in the community stick to their treatment regimes.

The government in England proposed Supervised Community Treatment as part of its Amendment Bill to the Mental Health Act 1983, announced in the Queen's Speech last week. Supervised Community Treatment would be similar to Scotland's community-based CTO system, but with some key differences - it will not require authorisation by an independent tribunal for instance.

Community-based Compulsory Treatment Orders in Scotland: The early evidence looks at the first six months of the new system, which is designed for 'revolving door' patients - those discharged from hospital into the community but who then stop taking medication or other treatment, and often end up back in hospital in a continuous cycle. If certain criteria are met, the new system allows health professionals to enforce treatment for these patients, to prevent them lapsing to the critical stage of hospital readmission.

Although too early to examine the impact on patients, the study was able to take an early look at whether the system seems to be working, and survey some staff involved in the new processes.

'The staff we talked to felt the new system was fairer and had better safeguards for patients,' said the report’s author, Simon Lawton-Smith, senior fellow in mental health at The King's Fund.

'They also felt that fears of a rise in the use of compulsion to treat mental health patients had failed to materialise, and that community-based CTOs were only being applied when considered absolutely necessary. Worries that they would be used to push patients into the community to relieve pressure on hospital beds proved unfounded amongst staff.'

But the report showed there were serious concerns over resources. Staff on the front line felt burdened by the bureaucracy involved in applying for CTOs. And they felt there was no sign of the extra money given to local authorities by the Scottish Executive, for more staff for instance, crucial for implementing the new system. They were worried this could lead to other patients in their care losing out if the funding failed to filter through.

The King's Fund chief executive Niall Dickson said:

'Although these are very early findings, this study has important implications and should prove useful to politicians considering changes to mental health laws in England and Wales.

'It will be vital to understand the implications for staff who will have to implement the changes and they will need to be involved in the design of the new processes. The system seems to have worked in Scotland so far partly because staff were confident it was fair for patients - any changes to compulsory arrangements in England will also have to ensure patient rights as well as their safety and that of the wider community.'

Read the report: Community-based Treatment Orders in Scotland: The early evidence

Notes to editors: 

  1. For further information or interviews, please contact the King’s Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  2. Community-based Compulsory Treatment Orders in Scotland: The early evidence, by Simon Lawton-Smith, is free to download from Monday, 20 November.
  3. The King’s Fund is planning to conduct a further study of Scotland's community-based CTO system one year on from its inception. A report will be published in summer 2007. 
  4. The King’s Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.