Community Treatment Orders have been shown to be non-therapeutic and tend to impose compliance on ethnic minorities more than others.
This month, the interim report of the independent Mental Health Act Review was published. At Mind, we welcomed this long overdue review. At over thirty years old we believe the Mental Health Act is a piece of legislation that is no longer fit for purpose.
Black people are almost nine times more likely to be subject to a requirement, such as attending monthly appointments for slow-release injections, in order to avoid detention.
In the past three decades, a great deal has changed in the way mental health problems are viewed and treated. The public now has much higher expectations about the quality and availability of mental health services, as well as an expectation that people experiencing mental health problems will not face stigma or discrimination.
This Review is an important opportunity to fight for legislation that gives people choice, control and dignity in how they’re treated. This is especially important for people from Black, Asian and Minority Ethnic (BAME) backgrounds who are disproportionately likely to be held against their will under the Mental Health Act. We have been listening to what people with lived experience think of the Act so we can feed into the Review and make voices heard.
One of the areas the interim report brings into question is the efficacy of Community Treatment Orders (CTOs) which can be used when you are well enough to leave hospital, to impose certain rules such as the treatment you have and where you live. They are supposed to stop people ending up back in hospital, but the evidence suggests they don’t work.
- See also: CTOs and nearest relative rules face axe under new Mental Health Act
- See also: Stereotyping persists in our profession
- See also: So U Think i'M Crazy reminds us all to look after ourselves, regardless of race
CTOs were introduced in 2008 to promote compliance with mental health treatment in the community and to reduce people reaching crisis again and readmissions to hospital, but are being used far more than the Government originally predicted. The number of people subjected to them fluctuates, but it is still continuously high despite findings from a studies showing they are not effective for the majority of people. Last year, over 5,000 people were subject to CTOs in England and Wales. Research has concluded that they are no more effective than previously existing powers, yet they are far more restrictive and can last much longer.
Particularly concerning is the racial disparity in the use of CTOs. Black or Black British people are almost nine times more likely to be given a CTO than their White peers. People have told us that CTOs are a way of controlling Black communities. It is clear that something isn’t working.
Threat-based approach to mental health needs to end
People have described being on a CTO as feeling like they’re ‘stuck between a rock and hard place’, whereby they’ve been released from hospital but if they fail to follow the rules they’ll be sent straight back into hospital. Despite being expected to comply with certain rules, being under a CTO doesn’t necessarily mean receiving a good level of support – it may be just a monthly appointment for a depot injection.
Although some do see it as a positive as it helps them to stay out of hospital, they felt it was still based on threat. By its very nature a CTO can feel disempowering, when you’re meant to be at home and getting better. It was only a little better than being in hospital as it felt intrusive – for example, having to take medication in front of staff in their own home.
Overwhelmingly, people told us that they felt that when they left hospital the focus should be access to other treatment options: talking therapies, respite care and wider community programmes, rather than enforced medication and restrictive rules.
Beyond CTOs, there are wider problems with the Mental Health Act that need addressing too. It is vital that people who are at their most unwell are given dignity and this isn’t happening at the moment.
We know that we can’t look at the Act in isolation, without addressing the ongoing failures in mental health services which result in people ending up in crisis. People need to have easy, early access to high quality, culturally-appropriate care, and there need to be sufficient, well-trained staff and a crisis care pathway that works smoothly. Any changes to the Mental Health Act need to be delivered alongside the current and future plans to transform mental health services. We will be working hard to make sure that this Review improves the experience of people with mental health problems in the health service.
Alison Cobb is Senior Policy and Campaigns Officer at Mind.