Compulsory treatment in the community: concept and controversy

On 3 November 2008, new powers which allowed supervised community treatment, implemented by community treatment orders, came into effect in England. These orders were presaged by the Mental Health Act 2007 and contain specific conditions with which a patient must comply. The thinking behind the new orders was that patients in the community who are likely to be non-adherent to treatment could be treated under compulsion at an early stage in a relapsing phase of their illness, in order to prevent further relapse into serious illness, which could lead to their recurrent and compulsory admission to hospital. If patients who are to be treated in the community refuse to comply, they can be held in hospital against their will for up to 72 hours and forcibly treated. They cannot be forcibly compelled to accept treatment in the community. The legislation was controversial and was by no means universally supported. Some have argued that the motivation behind the introduction of new powers to allow ‘compulsory treatment in the community’ was more to assuage public anxiety about the potential threat to them caused by some people with mental health problems, a threat that is arguably in the public mind far greater than reality, than to provide a more liberal regime for the management of seriously ill psychiatric patients.