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Category:CTO cases


The old category structure used on this page is comprehensive as it contains every relevant case. The new database structure was introduced in 2019. It is more potentially useful than the old categorisation system: it includes all cases since January 2017, but only a minority of older cases: see Special:Drilldown/Cases. The pages below are initially ordered according to the dates on which they were added to the site (most recent first). The order can be changed by clicking on the symbol beside a column heading: click on the symbol beside "Page and summary" for alphabetical order; click beside "Categories" for the order in which the cases were reported. Click on the arrow symbol again to reverse the order. Click on a page name to view the relevant page. Asterisks mark those cases which have been added to the new database structure.

Case and summary Date added Categories
* Timing of CTO discharge R (Gisagara) v Upper Tribunal [2021] EWHC 300 (Admin) — The Responsible Clinician's evidence to the MHT was that the Community Treatment Order (CTO) criteria were met, and that a CTO was an "essential precondition" to discharge as otherwise the patient would not accept medication; she had granted s17 leave while the CTO was being arranged. When the MHT did not discharge him from s3, the patient argued that: (a) the discharge criteria mirror the admission criteria, s3(2)(c) requires detention, and the tribunal had failed to determine whether he was detained or merely liable to be detained; (b) the CTO criteria are incompatible with the detention criteria. In this application for permission for judicial review of the Upper Tribunal's refusal of permission to appeal, the Administrative Court decided that: (a) in relation to the principle that the discharge criteria mirror the admission criteria, there was no conflict of authority (the Court of Appeal had repeatedly agreed with the House of Lords on this despite the Court of Appeal decision to the contrary never having been overruled) so there was no important point of principle; and (b) there no arguable case. Permission was therefore refused. 2021‑02‑18 00:13:00 2021 cases, CTO cases, Cases, Judgment available on Bailii, Pages using DynamicPageList3 parser function, Judgment available on Bailii, 2021 cases


* Lawfulness and availability of treatment PM v Midlands Partnership NHS Foundation Trust [2020] UKUT 69 (AAC) — The tribunal had been wrong to find that appropriate medical treatment was "available" for a CTO patient for whom the lack of a SOAD certificate meant that two days after the hearing her treatment could not lawfully be given (unless she were to be recalled to hospital and the administration of her depot were to become immediately necessary). This was the case even though the treatment could have been given on the hearing date: the tribunal should look at the whole course of treatment, not merely a snapshot. 2020‑04‑01 21:30:03


* CTO and DOL Welsh Ministers v PJ [2018] UKSC 66 — (1) There is no power to impose conditions in a CTO which have the effect of depriving a patient of his liberty. (2) The patient's situation may be relevant to the tribunal's discharge criteria, and the tribunal may explain the true legal effect of a CTO (for the RC to act on that information), but if a patient is being unlawfully detained then the remedy is either habeas corpus or judicial review. 2018‑12‑17 14:40:29 2018 cases, Brief summary, CTO cases, Cases, Deprivation of liberty, Judgment available on Bailii, Pages using DynamicPageList3 parser function, Transcript, Judgment available on Bailii, 2018 cases


* Tribunal reasons M v An NHS Trust [2017] MHLO 39 (UT) — "[T]he tribunal's decision was made in error of law, but not [set aside]. In my grant of permission, I identified two possible errors of law. ... One of those errors was that the tribunal's reasons might be inadequate for being 'long on history and evidence but short on discussion.' ... There is, in truth, only one thing that really has to be said about the quality of reasons, which is that they must be adequate. Everything else is merely application of that principle to the circumstances of a particular case. ... [T]he second possible error [is] that the 'tribunal's reasoning shows that it was confused about its role and the [relevance] of a community treatment order'. ... [T]he reasons at least leave open the possibility that the tribunal may have strayed outside its proper remit. ... The first three sentences read: 'A cardinal issue of this application is whether the patient should be discharged from hospital by a CTO. This issue involves knowledge of the nature of a CTO. A CTO may only be imposed by the patient's RC ...' It may be that the judge did not express himself clearly, but that passage appears to begin by suggesting, and to continue by denying, that the tribunal had power to make Mr M subject to an order or was being asked to approve that course. The judge did then make a distinction between discharge from hospital and discharge from the liability to be detained. So it is possible that his reference to 'discharge from hospital by a CTO' may have been intended, not as a direction about the tribunal's powers on the application, but as a statement of how the responsible clinician envisaged Mr M's eventual progress. This interpretation would be consistent with what the tribunal said later ... In view of Mr M's current status [he had been discharged], I do not have to decide whether those reasons do or do not show that the tribunal misdirected itself. I limit myself to saying that it is risky if reasons can be read in a way that indicates a misdirection. ... Given that Mr M is no longer liable to be detained, I can see no need to venture outside the appropriate role of the Upper Tribunal in mental health cases and state, even in the form of a narrative declaration, that the tribunal should have exercised its power to discharge him. That is why I have exercised my power to refuse to set aside the tribunal's decision regardless of any error of law that it may have made." 2018‑01‑27 22:25:39 2017 cases, CTO cases, Cases, Judgment available on MHLO, Neutral citation unknown or not applicable, Pages using DynamicPageList3 parser function, Transcript, Upper Tribunal decisions, 2017 cases


* DOL discharge conditions SSJ v MM; Welsh Ministers v PJ [2017] EWCA Civ 194 — (1) MM wanted to be conditionally discharged into circumstances which would meet the objective component of Article 5 deprivation of liberty. The Court of Appeal decided that: (a) the tribunal has no power to impose a condition that is an objective deprivation of liberty; (b) a general condition of compliance with a care plan would be an impermissible circumvention of this jurisdictional limitation; (c) purported consent, even if valid, could not provide the tribunal with jurisdiction. (2) PJ argued that his CTO should be discharged as it could not lawfully authorise his deprivation of liberty. The Court of Appeal decided that a CTO provides the power to provide for a lesser restriction of movement than detention in hospital which may nevertheless be an objective deprivation of liberty provided it is used for the specific purposes set out in the CTO scheme. 2017‑05‑07 23:52:25 2017 cases, CTO cases, Cases, ICLR summary, Judgment available on Bailii, Pages using DynamicPageList3 parser function, Judgment available on Bailii, 2017 cases


* CTO DOL condition PJ v A Local Health Board [2015] UKUT 480 (AAC) — The MHRT for Wales had rejected PJ's argument that his CTO should be discharged because its conditions unlawfully deprived him of his liberty. He appealed to the Upper Tribunal. (1) In deciding that PJ was not deprived of his liberty, the MHRT had erred in law in its application of the Cheshire West decision. (2) The MHRT also erred in law in concluding that the CTO framework must take precedence over any human rights issues. The tribunal must take into account whether the implementation of the conditions of a CTO will or may create a breach of Article 5 or any Convention right. If an issue remains to be decided on whether a breach exists or could be avoided (by authorisation or consent, or changing conditions), then generally the tribunal should adjourn to give an opportunity to make lawful the implementation of conditions. But if the treatment could not be provided without breach of Convention rights then the tribunal (whether by the statutory criteria or under its discretion) should discharge the CTO. (3) Guidance to tribunals was given under the following (paraphrased) headings: (a) whether implementation of the conditions will objectively amount to a deprivation of liberty; (b) whether the patient has capacity to consent; (c) if the patient has capacity, whether consent avoids a breach of Article 5; (d) if the patient lacks capacity, whether the objective deprivation of liberty can be authorised under the MCA; (e) if the patient lacks capacity, whether s64D can be relied upon to avoid an Article 5 breach; (f) how the conclusions on the above should help decide whether to adjourn, or discharge or uphold the CTO. (Caution: see Court of Appeal decision.) 2015‑09‑10 00:18:19 2015 cases, CTO cases, Cases, Judgment available on Bailii, Judgment available on MHLO, MHLR summary, Pages using DynamicPageList3 parser function, Transcript, Upper Tribunal decisions, Judgment available on Bailii, 2015 cases


GA v Betsi Cadwaladr University Local Health Board [2013] UKUT 280 (AAC), [2013] MHLO 50 — (1) Although the patient argued that he was not giving true consent to depot medication on a CTO, the tribunal decided that he was in fact consenting (this finding was not addressed on appeal). (2) If the tribunal have found that the statutory criteria are met (in CTO cases, effectively that the patient requires treatment and should be subject to recall), then, before granting a discretionary discharge, the tribunal must be satisfied that the identified needs for treatment and protection can be properly catered for, as otherwise the decision would be self-contradictory and perverse. [A more detailed summary is available on the case page.] 2013‑07‑04 16:17:31 2013 cases, CTO cases, Detailed summary, Judgment available on Bailii, MHLR summary, Pages using DynamicPageList3 parser function, Transcript, Upper Tribunal decisions, Judgment available on Bailii


CNWL NHS Foundation Trust v HJ-H [2012] UKUT 210 (AAC), [2012] MHLO 88 — The tribunal granted discharge from a CTO, deferred for 3 months, expressing the hope that in the meantime the RC would consider reducing the level of the patient's medication. The Trust appealed. (1) The challenge to the decision to discharge was essentially an attempt to re-argue the tribunal’s assessment of the evidence, and was therefore unsuccessful. In deciding on whether there is an error of law, the UT must respect the FTT's assessment of the evidence and fact-finding role (provided this was carried out rationally and explained): (a) the UT's statutory jurisdiction is limited to points of law; (b) the expert composition of the FTT means its fact-finding is worthy of such respect. (2) The challenge to the deferral also failed, as there was no evidence that the tribunal had misdirected itself by granting the deferral with the intention that that the patient's medication could be reduced in order to make her ready for discharge on a future date. (3) If the FTT's reasons for the deferral had not been set out adequately (ironically, the judge said the reasoning was 'not pellucid') then its decision would still not have been set aside; if anyone had cause to complain about the deferral it was the patient rather than the Trust. (4) If a CTO patient's condition deteriorates after a deferred discharge decision: (a) before the discharge date, he can be recalled under the CTO which still remains in force, and/or have his medication changed; (b) after the discharge date, he can be detained under s2 or s3, if there is information which was not known to the tribunal which puts a significantly different complexion on the case as compared with that which was before the tribunal. 2012‑09‑24 21:16:59 2012 cases, Brief summary, CTO cases, Judgment available on Bailii, Transcript, Upper Tribunal decisions


RN v Curo Care [2011] UKUT 263 (AAC) — (1) If the representative was right that the judge stated at the outset that the Tribunal would refuse to make a CTO recommendation, then reaching that firm conclusion (as opposed to an provisional opinion), and preventing the patient from arguing to the contrary, was a breach of natural justice and the ECHR right to a fair hearing. (2) In any event, the lack of reasons for not making the requested recommendation amounted to an error of law. (3) There would be no point in setting aside the decision if a recommendation were impossible or not a realistic possibility, but this was not a case where a CTO would never become a realistic option in the foreseeable future: the Tribunal can make a CTO recommendation not only if it considers that the criteria are satisfied (here it did not) but also in order to trigger consideration of future steps that could be taken to move the patient towards eventual release [not sure what this means]. (4) The decision was set aside and remitted to a differently-constituted panel for reconsideration. 2011‑05‑04 22:08:21 2011 cases, Bias cases, Brief summary, CTO cases, Judgment available on Bailii, Transcript, Upper Tribunal decisions


* CTO and deferred discharge MP v Mersey Care NHS Trust [2011] UKUT 107 (AAC) — The Tribunal panel discharged a s47 patient, deferred for six weeks for after-care arrangements, and also stated in para 9 of its decision that it 'would also invite Mr P's care team to consider whether to implement a community treatment order'. A CTO was then made; however, when the panel's decision to discharge the s47 took effect it also discharged the CTO. On the responsible authority's application under Tribunal rule 45, a salaried tribunal judge reviewed and set aside the panel's decision (on the basis that, by directing discharge, the panel had frustrated its intention that there be a CTO) and remitted the case to a fresh panel. The patient appealed, but the relevant decisions were excluded from the appeal jurisdiction so the appeal was treated as a JR application. The Upper Tribunal decided: (1) Where (as here) the panel find any of the statutory criteria not met, there is no power under s72(3A) to recommend a CTO: rather, there is a positive duty to discharge. (2) Para 9 was not expressed as a recommendation; the word 'also' showed that it did not form the basis of the reasoning; in so far as there is an inconsistency (between discharge and a recommendation), it is para 9 which should be given no weight; (3) The review decisions were quashed and a declaration made that the panel's decision be reactivated. 2011‑03‑30 21:14:44 2021 cases


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