Quick Guide: Recalls / Revocations

This guide is an attempt to “operationalise” complex issues and you should refer to your area’s 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.

• More detail on community treatment orders.
• More detail on conditional restricted discharge.
• More detail on restricted hospital orders.

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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Winner of the President’s Medal,
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award

 

All opinions expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2019

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I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current.  Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.

Government legislation website – www.legislation.gov.uk

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