MHTRs – orders without any home

The editorial by Taylor et al on the Sentencing Guidelines (2020) is welcome and rightly emphasises the availability of the Mental Health Treatment Requirement (MHTR) as an underutilised disposal for those whose culpability is diminished but not abolished by mental disorder, and whose longer-term mental health and recidivistic outcomes could be improved by a period of structured community supervision and treatment. Notwithstanding some problems that might exist with this order inherently (e.g. no review process for pharmacological treatment as directed, cf. a Mental Health Act Community Treatment Order; no form of review process as to ongoing suitability except in the context of a breach), one of the most challenging problems is whether there are going to be any mental health teams willing or structured to supervise it.

The NHS Long Term Plan and associated policy (e.g. The Community Mental Health Framework for Adults and Older Adults (2019)) is underpinning structural reorganisation of non-forensic community mental health services, whereby the community mental health team model is transforming to primary care network-embedded community teams with a much different remit in terms of long-term follow-up, being focused on interventions to improve quality of life and integration within services. Similarly, the care programme approach structure appears to be in the process of being ‘phased out’ in favour of an alternative, as yet unclear, structure.

Simultaneously, while the development of specialised community forensic teams is a welcome development, the gap in terms of not being universally commissioned to take on people with mental health problems released from prison, even if high risk, and indeed not all people discharged from secure services if the risk is deemed lower than threshold, is not likely to provide the supervision element of the MHTR.

My own experience of attempting to persuade both forensic and non-forensic mental health teams to take people under MHTRs is almost universally met with resistance, poor understanding of the framework and its uses, and a preference to ‘let the CJS deal with it and if they want to engage they can’. The sentencing guideline is therefore helpful for sentencers, but without significantly improved awareness among non-forensic professionals and a specific clear remit of the new networked teams to work with such orders, I fear that they will be used no more and possibly less than historically.