Community Treatment Orders used differently for people with learning disabilities

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Community Treatments Orders (CTOs) were introduced to enable people who had been detained under certain sections of the Mental Health Act 1983 to be discharged from the hospital and treated in the community. The supervising doctor however retains the power to recall that person to hospital if necessary

The majority of studies into the use of community treatment orders has focused on people with mental health issues who do not have a learning disability.  The researchers in this study were interested in looking at the application of such orders to people with learning disabilities in the UK.
What they did was to carry out an audit with learning disability consultant psychiatrists in Nottinghamshire. Each of the consultants was asked to provide information on

  • demographic data for patients on CTOs,
  • the reasons for being on a CTO,
  • conditions specified within the order,
  • patients’ capacity to consent
  • patients’ understanding of their CTOs.

They then used thematic analysis to explore the conditions of CTOs being used.

What they found was  that there were 17 CTOs for patients with learning disability from November 2008 to May 2011.

The mean age of those with CTOs was 38 years, although the youngest was 20 and the oldest 59.

All of the patients with a CTO were described as having a mild or moderate learning disability. Of those in this sample, only a small percentage of patients had a diagnosis of schizophrenia. However, over 50% had a diagnosis of pervasive developmental disorder (PDD).

In relation to the reasons for being on CTO, all the patients had behavioural problems cited. Over 30% of those on CTOs did not have any understanding of orders.

The thematic analysis of conditions found these were focused on providing a structured life to prevent relapse of the mental disorder.

The authors conclude that the audit identified that Community Treatment Orders appear to be used differently for people with learning disabilities to those without. They had been adapted to use for patients with behavioural challenges and pervasive Developmental Disorder which contrasted the use of CTOs to manage non-compliance with medication in patients with schizophrenia in the general adult population.

The use of Community Treatment Orders in an intellectual disability service, Perera B et al. in Advances in Mental Health and Intellectual Disabilities, 7, 3, 129 – 134

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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