Community Treatment Orders
Section 51 Mental Health Act 2007
What is a Community Treatment Order (CTO)?
A Community Treatment Order (CTO) is a legal order made by the Mental Health Review Tribunal or by a Magistrate. It sets out the terms under which a person must accept medication and therapy, counselling, management, rehabilitation and other services while living in the community. It is implemented by a mental health facility that has developed an appropriate treatment plan for the individual person.
A CTO authorises compulsory care for a person living in the community. If a person breaches a Community Treatment Order, by not complying with the conditions of the Order, the person may be taken to a mental health facility and given appropriate treatment, including medication.
CTOs can be made for any period of time up to twelve months. It is possible for a person to have more than one consecutive CTO.
When may the Tribunal make a CTO?
The Tribunal may make a CTO:
• for a person who is detained in or a patient in a mental health facility, or
• for a person who is not in a mental health facility.
A CTO may be made in the following circumstances and may replace an existing order (s51(5)):
• by a Magistrate following a mental health inquiry;
• on a review of a patient by the Tribunal;
• on an application to the Tribunal.
Who can apply to the Tribunal for a CTO?
The following persons may apply for a CTO (s51(2)):
• the Authorised Medical Officer of a mental health facility in which a person is detained or is a patient;
• a Medical Practitioner who is familiar with the clinical condition of the person;
• a Director of community treatment of a mental health facility who is familiar with the clinical condition of the person; or
• a primary carer of the person.
How does the Tribunal decide about a CTO application?
The Tribunal must be satisfied that:
• the person would benefit from the CTO as the least restrictive alternative consistent with safe and effective care; and
• the mental health facility has an appropriate treatment plan and is capable of implementing it; and
• if the person has been previously diagnosed as suffering from a mental illness, there must be a history of refusal to accept appropriate treatment.
The provision is essentially the same as the previous provision in the 1990 Act. So for example, the if an application was made in respect of a person who had for the first time been diagnosed as suffering from a mental illness, the Tribunal might decide that they would benefit from a CTO as the least restrictive alternative consistent with safe and effective care. If the person has previously been diagnosed then the requirement concerning “previous history of refusal to accept appropriate treatment” must be satisfied.
A person has a previous history of refusing to accept appropriate treatment if:
• the person has previously refused to accept appropriate treatment; and
• there was a relapse into an active phase of mental illness when treatment was refused; and
• the relapse was followed by mental or physical deterioration justifying involuntary hospital admission (whether or not there has been such an admission); and
• care or treatment in hospital resulted in, or could have resulted in, an improvement in or recovery from the symptoms of the mental illness.
When does a CTO come to an end?
A CTO can be made for a period of up to 12 months and ends on the date stated on the order, or if no date is specified, 12 months after the order was made. If you are applying for a further CTO, a hearing should be held before the current order ends to ensure continuity of care. However, an application can be made for a new order if a previous CTO has expired.
A CTO will also end if:
• the Director of the mental health facility revokes the CTO;
• the person successfully appeals to the Supreme Court; or
• the Tribunal revokes the CTO.
A CTO has no effect while an affected person is detained in a mental health facility or is a voluntary patient, or has been admitted after a breach of a CTO (s60).
Varying or revoking a Community Treatment Order
t is possible to ask the Tribunal to vary or revoke a CTO. However, an application may only be made (s65(3)) if:
• there has been substantial or material change in the circumstances surrounding the making of the order; or
• relevant information not available when the order was made has become available.
An application may only be made:
• by the affected person; or
• by the psychiatric case manager implementing the order; or
• by a person who could have applied for the order.
Variation
Typically a variation is needed when the client has moved into a different area, or there has been a substantial change in the treatment plan. For example, a new medication has been introduced which requires regular blood tests and this is not covered in the original treatment plan.
The mental health facility currently responsible for the CTO is the only facility that can apply for a variation of the order (see Attachment 4 – Application form for a variation of an order).
Revocation
As mentioned above, the Tribunal may revoke a CTO. However, the Director of community treatment of a mental health facility may also revoke a CTO if of the opinion that the subject person is not likely to benefit from a continuation of the order (s66). In that case, there is no need for a Tribunal hearing. If a person on a CTO wishes to have the order revoked, he or she can be referred to Legal Aid for advice on 9745 4277, or can contact the Tribunal directly for information about the process.
Appealing against a Community Treatment Order (s67)
If the order was made by the Tribunal the affected person may appeal to the Supreme Court if:
• the term of the CTO exceeds 6 months or no term is specified on the order, against the duration of the order; or
• on any question of law or fact arising from the order or its making.
If the order was made by a Magistrate, the Tribunal may hear the appeal.
Clients should be referred to the Mental Health Advocacy Service (Legal Aid) for advice on 9745 4277 or refer to the Tribunal if he or she is subject to a Magistrate’s order.
Breaches of Community Treatment Orders (s58)
Mental health facilities have certain powers to enforce CTOs and to deal with breaches by the affected person. A breach occurs when a person fails to comply with one of the obligations in the approved treatment plan. There are a number of steps to the breach process. It can end with the affected person being readmitted to a hospital based mental health facility as a detained person.
A technical breach of a CTO does not automatically result on breach proceedings. The process commences and continues at the discretion of the treating mental health facility.
The steps set out in the Act following a CTO breach are as follows:
1. If the affected person refuses or fails to comply with the order, the mental health facility should take all reasonable steps to implement the order and inform the affected person that he or she is not complying with the conditions of the order, and remind the person of the possible consequences.
2. If the person still does not comply with the order, the Director of the mental health facility needs to decide if there is significant risk of deterioration of the person’s mental or physical condition.
3. If the Director considers that there is a significant risk of deterioration of the person, the Director must make a written record of the facts on which that opinion is based and the reasons for forming it, and also include in that report the facts and reasons about the affected person’s failure to comply, and the steps have been taken to implement the order.
4. The case manager must then tell the affected person that if he or she still refuses to comply with the CTO, the person will be taken to the declared mental health facility or another appropriate mental health facility and treated there.
5. If the affected person still fails to comply, the Director of the mental health facility may organise a written notice (a breach notice) to be given to the person requiring him or her to accompany a member of staff of the agency for treatment, and warning him or her that the assistance of a police officer may be obtained to ensure the person obeys the notice.
6. If the affected person still fails to comply, the Director may issue an order (a breach order) in writing that the person is to be taken to a specified mental health facility.
A person who is at a mental health facility as a result of a breach notice or a breach order:
• may be given treatment in accordance with the CTO; and
• may be assessed by a medical practitioner for involuntary admission;
• may be released if treatment is accepted, or may be dealt with at the mental health facility or taken to another mental health facility if treatment is refused.
A person who is at a mental health facility after a breach order is to be reviewed by an authorised medical officer within 12 hours to determine if the affected person is a mentally ill or a mentally disordered person. If either determination is made and if no other care of a less restrictive kind is available the person must be detained in the mental health facility.
The affected person may be detained until:
• if mentally ill, the term of the current CTO ends or the person is discharged from the mental health facility;
• if mentally disordered, the maximum period for which he or she can be held as mentally disordered ends, the term of the current CTO ends or the person is discharged from the mental health facility.
NOTE: If the affected person is discharged before the CTO ends, then the CTO continues to have effect.
When will a person admitted under a breach be reviewed?
The status of a person admitted under the breach provisions will be that of a detained person in accordance with s19 of the Act (s62(3)).
An authorised medical officer must cause a detained person to be brought before the Tribunal not later than 3 months after the person was detained.
The Tribunal must decide if the person is a mentally ill or mentally disordered person for whom no care of a less restrictive kind is appropriate or reasonably available. If such a determination is made the Tribunal must determine whether the person should remain in the mental health facility until the end of the CTO.
If the Tribunal does not determine that the person is mentally ill, or if less restrictive care is appropriate and reasonably available it must make an order that the person be discharged from the facility and may make a new CTO. The Tribunal may defer the operation of the order for discharge for up to 14 days.
If at the end of the CTO the person is still a mentally ill person and there is no less restrictive form of appropriate care available the authorised medical officer may cause the person to continue to be detained in a mental health facility.
Civil Hearing Kit
For further information please select the following link to the relevant section of the Tribunal’s Civil Hearing Kit:
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