Surge in use of compulsory treatment orders sparks concern across Scotland

There been a near 50% rise in use of compulsory treatment orders across Scotland, a new report has found.

The Mental Welfare Commission has raised concerns over how compulsory community treatment orders (CCTOs) are working in Scotland, 20 years after they were introduced.

The report shows there has been a 44% rise in the use of the orders over a decade, from 941 in 2012 to 1,333 in 2022.

It also found that almost three quarters of the orders had been in place for over two years, with some people subject to a compulsory community treatment order for 17 years.

The orders were originally created to offer people with severe mental ill health the opportunity to get full support and treatment at home as they recovered.

Yvonne Bennett, senior manager at the Mental Welfare Commission, said: “We saw the law being used to make people take prescribed medication for many years, but little evidence of planning to support the person to come off the order or receive care and support that might lead to a more positive future – often all they get is compulsory medication.

“We were also concerned to find that those responsible for reviewing compulsory community treatment orders don’t always personally know the individual very well before renewing the order.

“When we spoke to people on these orders and their relatives, they supported the situation because they said it guaranteed the individual would get treated if there was a crisis. We understand that but don’t think it’s right – people should not have to live under a legal order just so they get treatment when needed.

“These orders remain a useful way of working with an individual and their family in their home, rather than in hospital. But we ask why so many people are on them, and for so long, without the therapeutic support that can lead to recovery and a better life.”

The Mental Welfare Commission spoke to 92 people who’d been on a compulsory community treatment order for over two years, almost 30 family members, and heard from over 300 medical and social work staff as it compiled the report.

The report’s findings support the Scottish Mental Health Law Review’s recommendation to the Scottish Government on this issue.

The Mental Welfare Commission hopes that government can use the detail of this report to improve the management of CCTOs and improve the outcomes for this vulnerable group of people.

Bennett added: “Compulsory community treatment orders should not be defined by a threat of a return to hospital or removal of services. They should be in the context of a collaborative, comprehensive recovery-oriented and inclusive approach.”