Supervised discharge orders

Sir: The editorial on supervised discharge orders by Burns (Psychiatric Bulletin, November 2000, 24, 401-402) raises many interesting issues, not least the fine balance between persuasion, coercion and enforcement. Although the supervised discharge under Section 25 of the Mental Health Act 1983 was primarily concerned with treatment in the form of medication, we would like to report our usage within a learning disability service, where the focus is on ensuring structured support rather than medication.

Working within a medium secure service at a tertiary regional level, all our in-patients are detained. About two-thirds of our patients have a combination of disability and personality disorder (ill defined) rather than ‘frank’ mental illness. A supervised discharge under Section 25 provides a legal framework, defining what services should be available and certain undertakings on the part of the patient: to live in a particular place; to meet with certain professionals; to attend certain day activities, etc. Even though it is clear that there is no enforcement, this structure does appear to give reassurance both to patients and staff, particularly to staff where the patient is discharged to.

It may be argued that this is no more than a Care Programme Approach (CPA). In our practice, however, we find that supervised discharge occupies an intermediate space between CPA and Guardianship Orders, perhaps a little bit more coercive than persuasive, but not using enforcement. We should be interested in the experience of other practitioners within learning disability services.