Misunderstanding recall

Smith et al ¹ should be congratulated for their investigation into the use of the additional conditions that are sometimes included in community treatment orders (CTOs). The Reference Guide to the Mental Health Act 1983 (15.16-15.19) and the Mental Health Act Code of Practice (25.29-25.35) describe the nature of these conditions and how they relate to the recall of patients. Although patients do not have to consent formally to CTOs, or the conditions, in practice they will need to attempt to cooperate with them. However, these additional conditions are not directly enforceable. The Reference Guide (15.30) sets out the criteria the responsible clinician must use when considering recall. These criteria do not refer to additional conditions, and there is no power of recall if a patient on a CTO fails to comply with them. I agree with Smith et al when they claim that many patients on CTOs wrongly believe that if they are unable to adhere to additional conditions they will inevitably be recalled to hospital, and that the prevalence of this misunderstanding is inconsistent with the principles set out in chapter 1 of the Mental Health Act Code of Practice. One of the roles of independent mental health advocates is helping patients obtain information about, and understand their rights under, the Mental Health Act 1983. In my opinion this is an issue that they should prioritise, as should all those who monitor the use of the Act. As Smith et al point out, these circumstances raise serious legal and ethical issues.