Quick Guide: Recalls / Revocations

  • This quick guide is an attempt to “operationalise” some complex issues but you should refer to your own force policy and your supervisors for specific local requirements.

This guide was written after an attempt by MH services to recall a CTO patient who had history of resistance and aggression.  The police said, “Sorry, we don’t have any powers to do that.”  This is wrong, although the police are not the only ones who do.

The recall / revocation of CTO patients is very similar to the re-detention of s42 conditional restricted release patients despite them being for very different categories of patient.

  • COMMUNITY TREATMENT ORDERS (CTOs) – INITIAL ACTION
  • Any patient on a CTO under s17A MHA can be recalled to hospital for up to 72hrs by their Responsible Clinician, a psychiatrist.
  • Ensure that a “recall notice” has been served upon the patient concerned – ask to see / have a copy.
  • This is important: examples exist where recall notices have not been served or served correctly and the police have still been requested to detain / convey.
  • The notice can be served personally or delivered by hand or by first class post – see below for when it takes effect because it is not necessarily immediate.
  • Request confirmation of the “RAVE Risk” information to influence the approach.
  • CONDITIONAL RESTRICTED RELEASE – INITIAL ACTION
  • Any patient previously detained under s37/41 MHA can be conditionally discharged by the Ministry of Justice under s42 MHA.
  • They may be recalled to hospital if the MoJ issues a warrant for their recall and return to hospital.
  • Ensure that a “s42 MHA warrant” has been issued for the patient concerned – ask to see / have a copy.
  • This is important: examples exist where recall notices have not been served or served correctly and the police have still been requested to detain / convey.
  • Request confirmation of the “RAVE Risk” information << There will usually be loads of it, because s37/41 patients by definition have been deemed to post “a significant risk of harm to the public.”
  • SUBSEQUENT ACTION – FOR EITHER CATEGORY OF PATIENT
  • Once detained, regard the patient as in legal custody and act as per any other MHA
  • Ensure an ambulance is called to convey the patient.
  • Assess and constantly re-assess for RED FLAGS whilst the person is conveyed.
  • Remove to A&E if any RED FLAG emerges at any stage.
  • Detain / restrain in the least restrictive way, with due regard to the person’s status as a patient.
  • Ensure you understand issues around the conveyance of MH patients.
  • LEGAL REMINDERS
  • If CTO recall notice served by hand – effective immediately
  • If CTO recall served by personal deliver – effective the next day
  • If CTO recall served by first class post – effective two working days later, ie: exclude weekends / bank holidays.
  • The CTO recall notice taking effect renders the patient AWOL for the purposes of s18 MHA.
  • There is no power of entry to detain someone under any circumstances of s18, unless s17 PACE or breach of the peace powers apply.
  • To force entry, a warrant under s135(2) is required.

Update on 01st April 2015 – since writing this article, a new Code of Practice has come into effect in England.  It doesn’t substantially alter the post but certain reference numbers have changed.  My summary post about the new Code of Practice (2015) is here, the new Reference Guide is here and the full document is here.  The Code of Practice (Wales) remains unchanged.

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6 thoughts on “Quick Guide: Recalls / Revocations

  1. My daughter is on a CTO right now. I think it is absolutely disgusting what is going on under the mental health system. I was a regular visitor at the shocking and horrifying Bethlem Royal Hospital research hospital where my daughter’s face got covered in bruises (no explanation given) and there is no protection for the patients. It was pitiful to see some of the sights on this horrific ward. Patients drugged up to their necks on a cocktail of chemicals that actually cause the condition of psychosis by inhibiting serotonin reuptake. These are not dangerous patients – it was pitiful to see these are human beings kept in a prison like hell on earth environment. It is not the patients that need to be watched it is the doctors and some of these nurses themselves who think they are above the law. By taking someone off 150mg of seroquel is bound to have some effect and then mixing this with Olanzapine and then Metformine off label for diabetes and then Clozapine as according to all t he information I have seen including shocking research papers and presentation, it is absolute abuse what is going on under the mental health system and just look how I myself am being treated. The law does not protect the innocent patients. The drugs companies are making a fortune, they are using weak and vulnerable patients and forcing them to take drugs whilst they experiment to their h earts content. I disagree with this law – it is rubbish for the most part to say these patients are a risk as they are so drugged up they can hardly move and anyone would be affected by these chemicals. I think the care in the UK is cruel and abusive and the law needs to be changed and psychiatrists are abusing patients human rights by playing on capacity as when someone is on a ridiculous quantity of drugs they are often incapable of thinking. I am just a mother but I am in touch with some leading professional doctors and there are many who do not agree with what is going on. When m y daughter was unstable on the Seroquel and suffering from Akathisia as a direct result of the drug itself she was constantly dumped back time and time again in her scheme and now the reverse complete abuse of human rights and look how many times they have threatened to arrest me as well trying to make out that I am the one aggressive. The files are full of untruthful comments whilst the team desperately try and stick together and protect one another and gang up against you when you disagree or dare to criticise the care like they are doing with me right now but unlike many mothers I am prepared to stand before the world and let strangers judge me and I am willing to show people and educate people as to how much suffering is going on by patients and carers alike.

    They have taken my daughter, put her in private sector as NHS care has failed, taken her miles away and insist on me having supervised phone calls and escorted leave. I have no regrets whatsoever speaking out against this infringement of human rights. Her diagnosis “treatment resistent” so why continue to drug her then along wi th other patients. It is the drugs themselves that cause the violence and aggression and a reduction should be done in a proper environment and if done correctly byu miniscule amounts on a day to day basis oer a two year period then things cannot go wrong as I am in touch with many patients and experts who will tell you it is not possible for someone to come off a huge amount like the Maudsley did and this is supposed to be a leading hospital! They would not listen and dismissed the books and CDs I had brought regarding this by professionals. Now I am not happy with the assessment and do not believe the diagnosis as there were several in the file but how on earth can you believe an assessment when such a high withdrawl has been done which in itself causes psychosis? I now want an assessment done by Dr Walsh who said he could help. Dr Walsh will look to see what kind of schizophrenia and then it is essential my daughter is on the correct diet. Nothing is being done correctly in this country and if I am prepared to pay for an assessment to be done then I do not see what the problem is. I cannot accept their diagnosis as it stands as the drug free period promised by Prof Murray was not done properly. Bethlem is about research and money is funded by the drugs companies. The rest of the acute wards all they do mainly is to push drugs and there is nothing much to do for the patients ont he ward certainly not at weekends.

    I was told by the consultant psychiatrist to sit back and trust the professionals but having read some of the shocking research papers how can I possibly have any trust whatsoever in them and especially after the way my daughter has been treated. This section should be removed as the psychosis was drug induced and the fault of the consultant psychiatrist in what he did and I have that in writing from an expert in the field – “it is like mixing pepsi with coke and that is how they keep people for their establishments as what they do know is any abrupt change or mixing of drugs can cause psychosis” Many of these people kept on CTO should be released and there should be humane care set up like Root and Branch Project, Soteria (open dialogue) and Chy Sawel – there is no decent care in the UK at present. I want a proper assessment for my daughter done by Dr William Walsh which I am prepared to pay for and he has been used by Scotland Yard.

    If anything happens to my daughter then the Bethlem Royal Hospital and Cambian Four Star Wards together with Enfield Mental Health have played a part. THEY ARE ALL FAILING MY DAUGHTER AND HAVE ABUSED HER HUMAN RIGHTS. Where is the law to protect these patients – you should make a point of visiting the patients on some of these horrific wards especially somewhere like the Bethlem where there are few visitors to see what is really going on behind closed doors. The article below explains what really goes on and how patients are suffering and I have written letters to leading politians as it is about time something is done about these laws regarding mental health and the shocking care available in the UK. – Here is a good example of care in the UK and this should be against the law in my opinion:

    http://nationalpsychosisunitsurvivor.blogspot.co.uk/

  2. Its very easy to criticize under resourced professionals. I note you are very unhappy with UK standards. I’m curious as to which countries are better than the UK, and how the UK can improve on a limited budget.

    1. I’m not criticising under-resourced professionals. Where I am criticising, I am criticising wasteful managers who leave staff under-resourced against their legal duties. We could improve on a limited budget – in mental health, policing and all other public sector areas – if we tackled to immense waste in our system.

  3. @Susan Bevis. CTO’s are a national disgrace. The use and abuse of CTO’s was predicted.

    This from the CQC

    “The number of people who are subject to the Act continues to increase. At the end of the year it was 5% higher than the year before – 20,938 on 31 March 2011 compared to 19,947 on the same date in 2010.

    Almost all of this increase is due to the rise in the number of people subject to a CTO. The number of people who remained subject to a CTO at the end of the year grew by nearly 30%, even though fewer new CTOs were started in this year than in last year, as fewer CTOs ended than were initiated during the year. This suggests that CTO powers, once implemented, may have quite a long duration, and that the population subject to CTO will continue to grow.”

    See this article for how CTO’s are disproportionate used against the BME community as well.
    http://www.guardian.co.uk/society/joepublic/2011/apr/06/black-people-face-mental-health-inequality

    CTO’s are imo dirty grubby instruments of power used by dirty grubby people. (im not referring to the police here, it’s worth noting that some psychiatrists refuse to use them.)

    1. In case of doubt, I was aware that you weren’t referring to the police. Interesting that there is no statutory maximum period that a CTO can operate for. I understand why there would not be if a patient had been detained under Part III as a restricted patient following a violent / sexual offence, but CTOs don’t apply there. We are invariably referring to s3 patients who have not been convicted of anything.

  4. I am a recently retired CPN, I am very concerned about what I feel is an abuse of the CTOs I had regular conflict with the inpatient services and refused to be part of the CTOs discharges. I felt is was worrying that CTOs were becoming a social control over anyone unfortuantly sectioned under sec 3 of the MHA.

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