5 MIN READ | Mental Health

In Defence of Compulsory Community Treatment Orders

Graham Morgan

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Graham Morgan, (2020, December 30). In Defence of Compulsory Community Treatment Orders. Psychreg on Mental Health. https://www.psychreg.org/defence-community-treatment-orders/
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Wendy, my partner, walks on ice like a daddy long legs on stilts! So yesterday, when we were walking along the boardwalk at the nature reserve on the hill between the Gare loch and Loch Long and we came to the end of the chicken wire protection on the wood, she stopped. She looked at the ice glistening and said: ‘I can’t go any further, I need help.’

The children giggled and I came back and gave her my hand and she hobbled. At the very end of the walk, back on the gravel, she danced in the air, said: ‘I made it!’ She laughed and made us all look at her trembling hands. It was a blue sky day and even some of the sea had frozen. I had got my injection in the morning and for the rest of the day we bounced and laughed, walked in forests and splashed in icy puddles.

I woke early this morning to Dash, the dog, standing on the bed beside me, staring down at me. We cuddled for a bit and then he settled down at my feet and we both slept. He is away now to see his doggy friends, to run in great excited circles. Later today we will go to the post office to buy a map of the elf trail that circles the village – a bit too young for the twins, but it should give us something to do on these days when there is not much we can do. Next week I go back to work and I think I am looking forward to it.

I am pretty unique in Scotland in that I have been on a compulsory treatment order for the last ten years or so and have been able to keep working for all that time and most of the time have a blessed life, filled with joy and warmth.

I see my psychiatrist as little as possible but have to see him, so, a week Monday I will do. I assume he will decide if I still need to be on my CTO.

If we forget the chaos of lockdown and Covid, I have nearly always had CPN’s who I trust and get on with. My present one was very kind to me the last time I told her I had emailed the local church pleading for sanctuary while also saying I was a devil and an atheist so I would understand if they refused it. She persuaded me to take some time off sick. I did and it worked.

I have extremely mixed feelings about my CTO. I know that my medication obscures from me just how truly evil and horrendous I am and just how badly I harm the world and those I love. I know that I have to face my reality someday – just as everyone else does – that I need to take responsibility for the harm I cause.

However, I have the most perfect life I could imagine at the moment. I dread the day I am free to stop my medication and face the reaction of those I love when the wonderful life I have falls apart.

My family tell me medication keeps me well. My heart refuses to believe I have schizophrenia. My mind tells me to let the state keep drugging me, that it is their fault if they want to keep me alive, by doing so.

My mind also tells me that I am almost a poster boy for the value of CTOs and so when I look at research about the effectiveness of CTOs, I get confused to see that there is almost no evidence that they work at all.

I am very much not an academic but when I look at measures of effectiveness, I find bed days, relapse, contact with community services, understandable, but strange things to use to see if they are effective.

It occurs to me that they need to be seen in the wider context of our life. Maybe people should look to see what else we have in our lives when we are on a CTO? Do we have love? Do we have money and things to look forward to? Do we have friends? Warm houses? Do we have a reason to get up in the morning? Can we sleep at night without fear of the thoughts that might overwhelm us?

I liked Dr Aisha Macgregor’s recent study of CTO’s in Scotland. In particular, I like how people said that there were huge issues of trust and power in the way they were treated and how the legislation was used, that it is about more than legislation.

I know I wouldn’t have good outcomes if I didn’t trust the person helping me and had to let them into my house. I would not have good outcomes if a condition of where I lived was to sign a recovery plan I didn’t want to abide by. Neither would I if, at the age of 57, I had certain hours I was allowed out of my supported accommodation and if I didn’t come back at the right time the police would be called. Neither would I if I had to agree to goals and targets and healthy eating. Or if I was told that I was not allowed to drink where I lived or who I could and couldn’t see.

I would hate it if I suddenly found myself categorised as a risk to staff if, in a moment of affection, I tried to give a member of staff a cuddle because she said something nice to me that I wasn’t expecting.

I am so lucky that I don’t need the level of support some of my friends and acquaintances need or maybe are given. I have never had to sign a contract saying how, when and who I can ask for help in a crisis. I haven’t been barred from services because of my attitude or, more poignantly, wondered if I will ever have a friend visit my house because they genuinely want to see me. Whether I will get more than one Christmas card at Christmas or wondered if anyone will call me on my birthday.

I wish I were more intelligent, but do you see my point? Measuring the effectiveness of CTO’s by the degree of contact we have with services. Or our relapse rate or how often we end up back in the hospital.

Of course, they won’t work if they are not created in combination with all the other things that might give us an almost liveable life. If these studies of effectiveness started from a different perspective and said we first have to check that the person concerned also has love, has some reason to look forward to the week, trusts and wants the people in their life to help them. If we said how much control of the rest of their life do they have? Or do they live in accommodation with rules and contracts and ways of living they have to sign up to but would never abide by if they had their own house and family?

Do they have the freedom to stay up all night playing music without fear of being evicted, or eat chips and sleep late and miss community meetings without worrying they are in breach of their recovery plan?

If we started with the idea that legislation will never work if the services we provide are not imbued with love and compassion and even a tiny sense of joy at meeting the people practitioners work with every day? Wouldn’t that be a better way of finding out what does and doesn’t work? And even of changing lives for something better and more hopeful?

The legislation seems to work for me. I think it is because I am surrounded by love, that I like most of the people who help me. That the drop in I never go to because I am almost mute on Zoom sent me a surprise Christmas present that almost made me cry with its unexpectedness and thoughtfulness. These are the things that make a difference in my life. The CTO is the bedrock, the safety net, but not the reason I live the life I do.


Graham Morgan is Joint Vice Chair of the Scottish Mental Health Law Review.


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