Supervised community treatment

Sarah Woolley suggested that given the lack of robust scientific evidence of the benefits of supervised community treatment (SCT), it was questionable whether psychiatrists in England and Wales would take advantage of the new SCT powers introduced in 2008. ¹

Although the collection of SCT data is still in its infancy, we have in recent months seen two reports on SCT usage. The Mental Health Alliance's briefing on SCT ² highlighted that the use of SCT in its first year was significantly higher than the government expected. From a survey of all active and retired members of the Royal College of Psychiatrists that received 533 responses, 324 members thought the SCT powers useful, whereas 74 did not.

The Care Quality Commission's first annual report on the Mental Health Act ³ confirmed the high use of SCT. In a sample of 208 cases, the Commission found that 30% of patients subject to SCT did not have a reported history of non-adherence or disengagement - ‘This suggests that the high use of CTOs… could be a result of the powers being applied preventatively beyond the group of patients for whom they were primarily designed’.

We await better data on SCT from the Oxford Community Treatment Order Evaluation Trial (OCTET). In the meantime, however, it does appear that psychiatrists (and, of course, those approved mental health professionals who agree with them) are not being shy in using the SCT powers. In passing, it is worth noting that having an estimated 4000-5000 people living in the community under an SCT has led to no corresponding reduction in numbers of detained in-patients.