issue of community treatment and produced an internal review report [59]. In
addition the Royal College of Psychiatrists recommended a new supervision order,
which would enable compulsory treatment to be given in the community [60].
However, despite the calls for compulsory treatment orders, these provisions were
not introduced. Instead, a form of supervision order was enacted giving certain
powers to the supervisor. Crucially however, the supervisor's powers fall short of
compulsory treatment and arguably the supervision order is less effective for this
omission.
The Mental Health #Patients in the Community) Act 1995 amends the MHA by
introducing a series of new sections whereby `after care under supervision' can be
sought by the patient's rmo before the patient leaves hospital. The application is
made under section 25A and is designed to secure the appointment of a supervisor
and with a view to securing the provision of after care services by virtue of section
117 MHA. Only patients who have been detained under section 3 are liable for a
supervision application, and equally only section 3 patients will qualify for after
care under section 117. The making of a supervision order will not guarantee that
any after care services are in fact provided and given that after care responsibilities
are normally shared between the health and social services, resource implications
cannot be ignored. What is clear is that any mentally disordered patient who is
discharged and receives section 117 services, will not be liable to assessment to
contribute towards the cost of those services #Rv.Richmond London Borough
Council e xparte Watson and Others#1999)).
In addition to having to provide those services that the service provider assesses
as being needed under section 117, section 25D sets out further requirements
which may be imposed upon the individual. These are:
`#a) that the patient reside at a specified place;
#b) that the patient attend at specified places and times for the purpose of
medical treatment, occupation, education or training; and
#c) that access to the patient be given, at any place where the patient is residing,
to the supervisor, any registered medical practitioner or any approved social
worker or to any other person authorised by the supervisor.'These requirements differ only slightly from the powers of guardians appointed
under section 7 MHA, the difference being that the supervisor can require the
patient to attend at specified places for medical treatment. This may in all possi-
bility be an out-patients clinic or the community psychiatric nurse's clinic. If the
patient does not attend, the supervisor may take or convey the patient to the place
for medical treatment ± a form of community arrest perhaps? However, having got
the patient to the medical practitioner, there is no method prescribed in the
amended MHA to force the patient to comply with the treatment. Instead of a
compulsory community treatment order, what has been produced is a watching
power which merely enables the supervisor, in reality, to consider whether re-
admission to hospital is warranted in the event of failure to comply with treatment.
For the community nurse the after care under supervision presents very little
change in the way patients must be treated, since ongoing consent must be
checked and refusal complied with where the patient is capable. When a patient
refuses treatment, and is subject to supervision, the only additional duty will be to
Mental Health Nursing 179