"My experience and views of Community Treatment Orders"

When I was an inpatient on Bronte Ward, Laureate House, Wythenshawe Hospital in late 2016, my consultant psychiatrist was planning to put me on a Community Treatment Order with enforced depot medication against my wishes. The only reason this didn't happen was that I was released from his care by a tribunal - which wasn't in agreement with the plans (nor was my regular outpatient consultant, when she heard about them). I am alarmed to find that such coercive and heavy handed measures are still being enforced, particularly since CTOs have been proven ineffective. A study into their use, headed by the psychiatrist who proposed their introduction in the UK in the first place, which was published in The Lancet in May 2013 concluded that "In well coordinated mental health services the imposition of compulsory supervision does not reduce the rate of readmission of psychotic patients. We found no support in terms of any reduction in overall hospital admission to justify the significant curtailment of patients' personal liberty." A further study in 2016 found that "Community Treatment Orders do not deliver clinical or social functioning benefits for patients. In the absence of further trials, moves should be made to restrict or stop their use." I wonder why the results of these reports have not been assimilated into mental health policy at Wythenshawe Hospital (and probably elsewhere).

I made a complaint about the above issue to the NHS; however, it was investigated by a psychiatrist in the same trust and, perhaps unsurprisingly, it was not upheld. I don't want to take up NHS time by pursuing it any further. However, I do think there needs to be a change here - so I am posting my story on this website, in the hope it reaches some more enlightened and well informed thinkers within the NHS.

In case it is of interest, I will post some further details including why I think a CTO was especially unjustified in my own case

-------------------------------------------------------------------------------

T Burns et al 'Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial', The Lancet, 11 May 2013

Abstract: https://www.ncbi.nlm.nih.gov/pubmed/23537605

T Burns et al 'Coercion in mental health: a trial of the effectiveness of community treatment orders and an investigation of informal coercion in community mental health care', National Institute for Health Research, December 2016

I believe the plan to put me on a CTO with enforced depot medication was inappropriate for the following reasons:

a. I had said that I didn’t want to be put on a depot (apart from anything else, I am phobic about needles/injections, which I had stated).

b. I was compliant with taking oral antipsychotic medication at the time (in hospital).

c. I had been compliant with taking antipsychotic medication all the way up until my admission to hospital (I never stopped taking it).

d. Community Treatment Orders have been proven not to work (e.g. 'Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial' by Prof Paul Burns et al, published in ‘The Lancet’, March 2013).

e. Community Treatment Orders were intended for ‘revolving door’ patients, which I am not (my previous hospital admission was from December 2012-February 2013).

f. I did not pose a danger to other people (this has never been claimed) and the only danger I was claimed to pose to myself was ‘vulnerability’.

g. I made a full recovery from my manic episode at home/in the community (and continued to take my medication) following my discharge by my tribunal on 4/11/2016, proving that I did not need to stay on section for 28 days followed up by a 6-month section (Section 3) with a Community Treatment Order.

h. I consider Community Treatment Orders and enforced depot injections to be an infringement of personal liberty/demeaning and believe that the imposition of these on me would have had a significant detrimental impact on my mental wellbeing.

i. A depot injection would have given me no control over the amount of medication (antipsychotic medication carries severe physical health risks) I was receiving and I believe it would have been harder to negotiate on dosage compared to oral medication, thus increasing my sense of violation and powerlessness in terms of my own treatment/body. I have read that there is a very high risk of relapse following discontinuation of a depot injection.