Compulsion in Mental Health Rachel E. Perkins BA, MPhil (Clinical Psychology), PhD, OBE Senior Consultant, Implementing Recovery through Organisational Change Programme Co-editor of ‘Mental Health and Social Inclusion’ Journal Deputy Chair, EHRC Disability Committee

The prevailing narratives: recovery, increasing life chances, increasing access to treatment, improved mental health awareness and early identification of mental health problems … ‘parity of esteem’ The elephant on the table: The Mental Health Act (1983) If you have a ‘mental disorder’ you can be compulsorily detained in hospital and forcibly injected if you are deemed to be putting your own health and safety at risk or for the protection of others. People do NOT have to be deemed to lack capacity to make decisions under Mental Capacity Act in order to be compulsorily detained and forcibly treated In 2008 amended to include ‘Supervised Community Treatment Orders’ (CTOs) that allow people to be compulsorily treated in the community - and recalled to hospital if they fail to comply Major campaigns against introduction on Community Treatment Orders, but they were introduced anyway … The theory: the number of people forcibly detained in hospital would decrease Government estimated that there would be around 400-600 CTOs per year The reality has been very different …

Increase in detentions from 2013-14 to 2014-15 = 10% The highest year on year increase ever 52,851 50,707 50,182 46,677 Source: Health and Social Care Information Centrehttp://content.digital.nhs.uk/catalogue/PUB18803/inp-det-m-h-a-1983-sup-com-eng-14-15-rep.pdf

Research evidence: Now 3 ‘randomised controlled trials’ of CTOs including UK - Burns et al (2013) The Lancet CTOs do not improve clinical or social outcomes, do not decrease rate of readmission “The evidence is now strong that the use of CTOs does not confer patient benefits despite substantial curtailment of individual freedoms … and their current high usage should be urgently reviewed.” (Burns et al, 2013) But it is not just CT0s - the Mental Health Act is intrinsically discriminatory - with the ever increasing number of people detained and forcibly treated urgent action is needed. The review of the CRPD offers an opportunity to highlight this injustice.