Are there any regulations a supported living provider needs to be aware of when providing support to someone who has been discharged from hospital on a Community Treatment Order?

Answered by Barry Price

This is a complex area, it’s not just about the regulations that you are already working in line with, but the additional points to consider from a person-centred care provider’s perspective. To support someone to reintegrate back into the community can be both challenging and rewarding at the same time. Getting it right can have life-changing consequences for service users who find themselves in this maze. I have experienced the joy of getting it right and the pain when things go terribly wrong. Taking time with preparation is essential.

I feel it is important to point out that, depending on the reasons for the hospital admission, you may need to speak to your insurance provider and ensure that your CQC registration enables you to provide support to certain individuals post discharge on a CTO. It may also be that there are other considerations to take into account such as criminal records and any requirements for registration with police authorities in this regard.

Although CTOs allow people to leave hospital to an approved and appropriate setting, it is important for all involved to remember the individual is still under “The Mental Health Act” and they can be ‘recalled’ back to hospital under certain conditions.

At the top of any admission process, consideration of compatibility both for current service users and any potential new service user is that neither are placed at risk by other people’s behaviours or personalities, triggering a relapse leading to readmission. For example, if the person being discharged on a CTO has issues with alcohol and drugs, it may be inappropriate to place them in a service with others with these behaviours even if they are managed well, as this could be a trigger for relapse.

Compatibility is so often the biggest key to success and failure of community placements, so time and resources should be afforded here, even considering longer than average transitions and service visits so that any potential issues could be ironed out.

You would ordinarily follow all of the regulations that you currently do but support plans and risk assessments would need to factor in any conditions attached to the CTO and arrangements in place for crisis management in the event of relapse or failing to abide by the conditions required. Who is involved and how to access support services, such as an Independent Mental Health Advocate (IMHA), Community Psychiatric Nurse (CPN) or the CTO Care Coordinator.

Are there any tenancy implications with your housing provider to consider? Have they the capacity to sign a tenancy agreement or is there further work and support needed here such as intervention from the court of protection?

Do your staff need any additional training that is not already in place at your service such as communication, understanding mental health, or specific conditions? The Mental Health Act including specifics about CTOs and detention, often known as “Sectioning”, not forgetting 117 aftercare. Are there any additional training requirements around positive behaviour support, restrictive interventions? If so, do you have a BILD/Restraint Reduction Network accredited training provider in place?

The challenges you may face with the assessment and planning needed for supporting an individual with a CTO may seem complex and daunting, but the rewards for getting it right are worth the effort that needs to be put in place at the planning stage.

Please also take a look at the CQC website for Mental health and the Mental Capacity Act guidance.