New MWC report into the use of compulsory community treatment in Scotland

Considerable progress has been made in providing good compulsory community treatment, according to the Mental Welfare Commission for Scotland. The Commission looked into the care and treatment of almost 200 people treated under community-based compulsory orders.  

This was a new provision under the Mental Health (Care and Treatment) (Scotland) Act 2003. Before it was implemented many service users raised concerns about the new provision.  They had concerns that it would be overused or used simply as a tool to enforce compliance with medication.  They did not think that community services were well enough developed to provide the care and support needed in the community.
The “Lives Less Restricted” report found that, six years on, most of these concerns have been allayed and that mental health services have risen to the challenge of providing compulsory community treatment.  Most of the people interviewed stated that the order was at least of some benefit to them.  One even said “it is the best thing that has ever happened to me”.   The Commission found that care plans were good with evidence of appropriate care and support and good information and participation for service users and their carers.   The majority of people visited were living in good quality accommodation with good support for maintaining their living situation and managing their finances.  The report highlights this individual story:
“It is evident from speaking with Ms E, her husband, support worker and doctor that the compulsory community treatment order (CCTO) has changed her life.  The doctor said that, up to 2008, she had been severely neglecting herself. This was because, under the previous Act, she could not be compelled to receive ongoing community treatment. She has now been out of hospital for 3 years and has had no obvious symptoms of her illness. She has an excellent package of care which she is now willing to accept. Ms E told me that the CCTO was the best thing that had ever happened to her. Her husband was equally enthusiastic and said we should use her experience as a success story.”
Public Health Minister Michael Matheson said “it is extremely pleasing to see that this innovation for treatment introduced in the mental health act is working so well.  The Act was a major piece of legislation for the Scottish Parliament and enjoyed cross party support.  It was groundbreaking in its provisions for mental health care and safeguards for individuals and we have had interest shown in it from many other countries across the world.  One of the reasons for its success is the set of principles underpinning it.  One of these key principles is that of least restriction and it was this principle that led to the provision of the compulsory community treatment order.  It allows people to continue their journey of recovery in their own homes and community while providing an important safety net for the care and treatment that they need”
The report also makes some recommendations for improvement.  These were that services should review the order more frequently and plan with the individual towards a point where the order is no longer needed.  There also needs to be some focus on providing meaningful work, even on a voluntary basis, for people. 

The Scottish Borders has a high use of community compulsory treatment.  The report found evidence of good care planning and review of orders in this area.  Dr Cliff Sharp, Associate Medical Director, states “We have a lot of people treated in the community under the provisions of the mental health act, and our community teams work with the individuals to discuss their needs and put in place support to achieve the agreed goals.  This includes discussing with the individual what needs to be in place for the order to be removed and working towards maintaining engagement and therapeutic relationships even when compulsory measures are necessary. Our staff are all supported in how to take this forward and our care plans are structured to ensure these discussions take place.  We are happy to share this good practice with others”

Dr Donald Lyons, Chief Executive of the Mental Welfare Commission, says “We hope that service providers use the messages in this report to help people to recover from serious mental illness. Good care, treatment and support must be accompanied by services to improve the person’s overall quality of life. We continue to regard compulsory community treatment as a priority for our attention. We will look further at our findings from this report and our forthcoming work on crisis support and intensive home treatment. As the balance of care continues to move away from hospital and into community settings, we will be an important safeguard in ensuring that people are given the care that meets their needs and respects their rights.”
For more information please contact The Mental Welfare Commission on 0131 313 8777.