Mental Health Law: Analysis of CTO and Mental Health Tribunal

This report delves into the intricacies of Mental Health Law in England, focusing on the Mental Health Act of 1983 and its implications for individuals with mental disorders. It examines the roles of the Mental Health Tribunal and Community Treatment Orders (CTOs), which allow for treatment in the community. The report provides a detailed analysis of related legal provisions, including sections 2 and 3 of the Act, and relevant case laws such as R v. Wilson, ex parte Williamson, Savage v. South Essex Partnership NHS Foundation Trust, Rabone v. Pennine Care NHS Foundation Trust, and Djaba v West London Mental Health NHS Trust. The report also includes a case study of a patient named William, exploring the application of the Act in his situation, including his detention and treatment for anxiety, depression, and potential psychosis. The analysis covers the rights of patients, the responsibilities of healthcare professionals, and the legal frameworks governing mental health care and patient rights.

Running head: MENTAL HEALTH LAW
MENTAL HEALTH LAW
Name of the Student
Name of the University
Author Note

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Introduction
In the nation of England, the ‘Mental Health Tribunal’, which is also called the ‘First-tier
Tribunal’, is considered to be an autonomous and self-governing body of quasi-judicial nature
that was introduced in order to provide protection to the rights and privileges in relation to
individuals who all fall under the Mental Health Act enforced in the year of 19831. This
particular kind of tribunal considers the appeals that are filed in contradiction to
medical detention or the involuntary and enforced treatment in relation to an individual, who
might have been suffering from any kind of mental sickness or disorder, which was connected to
any particular danger or jeopardy regarding the safety or health of that particular individual or
other people2. ‘Community Treatment Order’ or CTO is considered to be a fragment of Mental
Health Act enforced in the year of 1983. A CTO provides permission to any particular individual
to leave the treatment center or the hospital so that the individual may be treated in a safe manner
in the community instead of in the treatment center or the hospital. As per the CTO the
individual must adhere to specific conditions while staying in the community3. The paper
discusses a particular scenario and forwards a critical analysis in relation to the law regarding the
‘Community Treatment Order’ as well as ‘Mental Health Tribunal’.
Related Law
The Mental Health Act, which was enforced in the year of 1983 is a particular Act that
was introduced by Parliament regarding the nation of the United Kingdom. The application of
the aforementioned Act is done to the populace of the nation of England and the nation of Wales.
1 Mental Health Act, 1983
2 Jewell, Amelia, et al. "Predictors of Mental Health Review Tribunal (MHRT) outcome in a forensic inpatient
population: a prospective cohort study." BMC psychiatry 17.1 (2017): 25.
3 Kisely, Steve R., Leslie A. Campbell, and Richard O'Reilly. "Compulsory community and involuntary outpatient
treatment for people with severe mental disorders." Cochrane database of systematic reviews 3 (2017).

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This particular Act encompasses the response, care, maintenance, attention and treatment in
relation to the mentally disordered individuals. The Act also encompasses the administration,
management and supervision in connection to the property of such mentally disordered
individuals and other associated matters. It may be stated that the Act mentioned above, forwards
a legislation, with the help of which the individuals who all are detected and identified as having
a mental disorder may be detained, arrested or apprehended in police custody or in the hospital,
so that assessment and treatment may be done in relation to the disorder of such individuals in
contradiction to the wishes of the detained individuals. Such process, relating to the detention of
individuals who all are diagnosed as being mentally distorted, is familiarly called the procedure
of "sectioning"4.
Section 2 as provided in the Mental Health Act of the year 1983 delivers provisions in
relation to the admission of mentally disturbed individuals for the assessment of such
individuals5. This section provides that admission of a particular patient may be done in any
particular infirmary. The patient shall be detained in the infirmary or hospital for certain period
as provided in the aforementioned Act. An application must be made regarding such admission
for the purposes of the assessment of the patient and the application must contain the grounds for
such assessment. Such application must be made after recommendations from two registered
health experts. It must be mentioned that when an admission in relation to a particular patient is
made in any particular infirmary for the purposes of assessment as per the application made on
that behalf, then the detention of the patient must not exceed the time period of a number of
twenty eight days, which is counted from the day of admission. However, it may be stated that
4 Shaw, Ian, and Hugh Middleton. Understanding Treatment Without Consent: An Analysis of the Work of the
Mental Health Act Commission. Routledge, 2016.
5 Mental Health Act, 1983

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the detention of the patient shall not be given effect beyond the aforementioned time, unless
further application, direction or order has been made for the purposes of his detention.
The case of R v. Wilson, ex parte Williamson [1996] COD 42 is considered to be a
relevant case in this regard. In this particular case, the court stressed and accentuated the
significance of the utilization of the correct and suitable section for the detention of a particular
patient6. The utilization of section 2 as provided in the aforementioned Act must be for a
restricted time period and the purpose of the utilization must be limited. This particular section
must be utilized in order to evaluate the condition of any particular patient so that the right
treatment may be determined that may be proper and effective. After the provisions of section 2
are applied, it helps to determine that whether provisions of section 3 would be appropriately
applicable or not. However, it may be said that as per several reports and studies in this regard
section 2 of the aforementioned Act is being utilized far beyond the contracted parameters or
restrictions.
Section 3 as provided in the aforementioned Act delivers provisions in relation to the
admission of the patients for an appropriate treatment7. The application shall be made for the
admission of the patient on grounds such as mental disorder, mental sickness and psychopathic
disorder. Recommendations for such application must be made by registered health experts.
In the case of Savage v. South Essex Partnership NHS Foundation Trust [2008] UKHL
74, it was stated that failures to give effect to rational and sensible precautions in order to
provide protection to the lives regarding patients who have thoughts of suicidal nature, shall be
6 R v. Wilson, ex parte Williamson [1996] COD 42
7 Mental Health Act, 1983

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considered to be a violation of Article 2 as provided in the European Convention on Human
Rights (ECHR)8.
The case of Rabone v. Pennine Care NHS Foundation Trust [2012] UKSC 2 is
considered to be a relevant case law in this regard. In this particular case, it was held by the
Court that the effective and functioning obligation and responsibility to provide protection
regarding lives may be owed to patients who are detained or apprehended formally and such
responsibility may also be due to the informal and casual psychiatric patients as per the
provisions of the Act of 1983 that is mentioned above9. Such responsibility is based on the
supposition of an obligation of the State in favor of the wellbeing, safety and health of each
particular individual of the State. Such views had been taken in this particular case as per the
previous cases namely, Osman v United Kingdom (1998) 29 EHRR 24510 and LCB v United
Kingdom [1998] ECHR 10811. In the case of Reynolds v. United Kingdom (2012) 55 EHRR 35, it
was agreed by the European Court that such responsibility or obligation may be owed to an
informal patient relating to mental disorder12.
The effect and influence of the cases mentioned above have been significant. In the case
of Powell V United Kingdom (2000) 30 EHRR CD 362, it was mentioned that it is very much
essential that the services relating to health should guarantee and make sure that high standards
of professionalism are met and operative and effective structures regarding work are
appropriately positioned13. It must be mentioned that there is the existence of acknowledgement
in relation to the operational and effective responsibility in order to provide protection to the life
8 Savage v. South Essex Partnership NHS Foundation Trust [2008] UKHL 74
9 Rabone v. Pennine Care NHS Foundation Trust [2012] UKSC 2
10 Osman v United Kingdom (1998) 29 EHRR 245
11 LCB v United Kingdom [1998] ECHR 108
12 Reynolds v. United Kingdom (2012) 55 EHRR 35
13 Powell V United Kingdom (2000) 30 EHRR CD 362

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regarding any particular individual in circumstances relating to risk of suicide, where it may be
evident or may have been evident that there existed a ‘real and immediate risk of suicide’, as
mentioned in the case of Re: Officer L [2007] UKHL 3614. Such acknowledgement has secured
and strengthened the responsibility that is levied upon the professionals relating to health care.
Cases like Rabone and Savage provided the importance and implications relating to the
fact that the public institutions should accept and undertake the duty in relation to the helpless
and vulnerable individuals. The case of Cheshire West and Chester Council v P [2011] EWCA
Civ 1333 also laid down principle in this regard and supported the importance and implications
mentioned above15.
Sub-section 2 of section 5 as provided in the Act mentioned above, states that if it is
evident to the registered health expert that the patient who is already admitted in a particular
hospital, needs further admission in a hospital and an application must be made in that regard,
then that particular health expert must deliver a specific report that must be in writing, to the
management in relation to such further admission regarding the patient16.
The case of Djaba v West London Mental Health NHS Trust [2017] EWCA Civ 436 is
considered to be a relevant case law regarding the given scenario in the assignment. In this case
it was stated that the appeal is regarded with the constricted question that whether the legislative
assessments contained by section 72, section 73 and section 145 as provided in the Mental
Health Act of the year 1983 necessitate the conducting of a 'proportionality assessment', in
pursuant to Article 8 and Article 5 regarding the ECHR17. Such assessment may also be
considered in relation to the Fundamental Freedoms and the Human Rights Act enforced in the
14 Re: Officer L [2007] UKHL 36
15 Cheshire West and Chester Council v P [2011] EWCA Civ 1333
16 Mental Health Act, 1983
17 Djaba v West London Mental Health NHS Trust [2017] EWCA Civ 436

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year 199818. Such question may be determined after the consideration of the conditions in
relation to the detention of the appellant. The locus that is established is that where there is the
existence of a question relating to the fact that whether the specific detention of the patient is in
compliance to and follows the ECHR, should it be counted particularly among the authorities
and controls relating to the tribunals. However, the question is also relating to the fact that
whether such compliance related question can be brought before any other proceedings. As a
response or a deliberation it may be said that section 3 as provided in the Human Rights Act of
the year 1998 does not mandate the controls or authorities regarding the tribunals to be construed
and understood in relation to the aforementioned Convention so that powers and authorities may
be provided to them in order to contemplate compliance with the Convention. In the
aforementioned case, such principles have been applied. In this particular case it was mentioned
that an application must be made by the appellant for the purposes of a judicial review. The
application must made in favor of the Administrative Court. Such application shall be made if it
is considered by the appellant that the conditions and circumstances in relation to his detention
and apprehension are unbalanced, uneven and inconsistent, and the detention is not in
compliance to the aforementioned Convention. After the application has been made the Court
shall have the ability to give effect to an adequate review in relation to the merits, values and
virtues in order to fulfill the essentials regarding the Convention19.
William’s Case
In the given scenario, William is regarded as the patient. He has been suffering from
anxiety and depression for a time period of twelve years. William has insisted that such mental
18 Fundamental Freedoms and the Human Rights Act, 1998
19 LAURIE, GRAEME HARMON, and Edward Dove. Mason and McCall Smith's law and medical ethics. Oxford
University Press, 2019.

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condition is because of the stressful nature regarding his work relating to sales. William was
involved in an altercation at the place of work for which he was apprehended by the police.
While being apprehended, William began injuring himself and when the police officers made an
attempt to confine him, he attacked the officers and caused injuries to officers as well as himself.
William was admitted in hospital pertaining to his mental condition. Dr. Johansen, who was
responsible for the assessment and treatment of William, initially stated that detention of William
should be given effect as per the provisions of sub-section 2 of section 5 as provided in the Act
of 1983. However, afterwards, after detaining William in ‘Mental Health Unit’, it was stated by
Dr. Johansen that William must be kept in the hospital as per the provisions provided in section 2
of the Act mentioned above, in order to do a full assessment of William regarding his mental
condition. Later on, after proper diagnosis, it was affirmed that William may be regarded as a
patient of clinical depression and he may experience occurrences relating to psychosis. Hence, it
was also stated by the doctor that William should also be kept in the hospital as per the
provisions of section 3 as mentioned in the Act mentioned above. However, William is of the
opinion that such detention is not in favor of his health and he shall recover successfully if he is
treated in his house.
The rule as provided in section 2 of MHA of 1983 should be applied in the given
scenario. This section delivers provisions in relation to the admission of mentally disturbed
individuals for the assessment of such individuals20. It may be said that the actions of William
cannot be considered as that of a normal individual. His actions in his office and in the police
custody demonstrate that his mental condition is not entirely all right. Hence, it is very much
essential that the mental health of William should be assessed and evaluated in an appropriate
manner as per the provision of section 2 of the Act mentioned above.
20 Mental Health Act, 1983

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The rule forwarded in the case of R v. Wilson, ex parte Williamson [1996] COD 42 shall
be applicable in the given scenario21. In the case, the court has stressed and accentuated the
significance of the utilization of the correct and suitable section for the detention of a particular
patient. It has also been mentioned in this case that the utilization of section 2 as provided in the
aforementioned Act must be for a restricted time period and the purpose of the utilization must
be limited. Such rules must be followed by the institution and health experts who shall be
responsible for the assessment and treatment of William. It is mandatory that this particular
section must be utilized in order to evaluate the condition of any particular patient so that the
right treatment may be determined by the health experts, which may be proper and effective.
The rule of section 3 as provided in the aforementioned Act, which delivers provisions in
relation to the admission of the patients for an appropriate treatment, shall be applicable in the
given scenario22. In the provided scenario, Dr. Johansen has suggested the application of section
3 in relation to the case of William after the diagnosis report of William mentioned that William
had been suffering from clinical depression and might suffer from occurrences relating to
psychosis. Hence, it can be said that such application of section 3 by the doctor is adequate,
considering the mental sickness of William.
The case of Savage v. South Essex Partnership NHS Foundation Trust [2008] UKHL 74
shall be applicable in the given scenario. It may be said that if the Department regarding mental
health fails to give effect to rational and sensible precautions in order to provide protection to the
lives regarding patients who have thoughts of suicidal nature, then such failure may be
21 R v. Wilson, ex parte Williamson [1996] COD 42
22 Mental Health Act, 1983

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considered to be a violation of Article 2 as provided in the European Convention on Human
Rights (ECHR)23.
The rule forwarded in the case of Rabone v. Pennine Care NHS Foundation Trust [2012]
UKSC 2 shall also be applicable in the given scenario24. It should not matter that whether
William has been detained formally, or whether he may be considered as an informal and casual
psychiatric patient, as per the provisions of the Act of 1983, the health department of the State
shall be obligated towards the wellbeing, safety and health of William.
The rule forwarded in the case of Powell V United Kingdom (2000) 30 EHRR CD 362
shall also be applied in the given scenario25. It shall be mandatory for the medical institution and
the doctor who are responsible for the treatment of William, to ensure that the services relating to
health may guarantee and make sure that high standards of professionalism are met and operative
and effective structures regarding work are appropriately positioned.
The rule mentioned in sub-section 2 of section 5 as provided in the Act mentioned above
may also be applied in the given scenario. If it is evident to the registered health expert that the
patient who is already admitted in a particular hospital, needs further admission in a hospital and
an application must be made in that regard, then that particular health expert must deliver a
specific report that must be in writing, to the management in relation to such further admission
regarding the patient26. Hence, it may be said that Dr. Johansen may act accordingly after
considering the mental health condition of William.
23 Savage v. South Essex Partnership NHS Foundation Trust [2008] UKHL 74
24 Rabone v. Pennine Care NHS Foundation Trust [2012] UKSC 2
25 Powell V United Kingdom (2000) 30 EHRR CD 362
26 Mental Health Act, 1983

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However, it may be said that William may have an opportunity regarding his discharge
from hospital. The rule as provided in the case of Djaba v West London Mental Health NHS
Trust [2017] EWCA Civ 436 must be applied in the given scenario in relation to the
aforementioned opportunity27. An application may be made by William for the purposes of a
judicial review. The application must made in favor of the Administrative Court. Such
application shall be made if it is considered by William that the conditions and circumstances in
relation to his detention and apprehension are unbalanced, uneven and inconsistent, and the
detention is not in compliance to the provisions of ECHR. Such application may be made as per
the provisions provided in section 72 and section 73 of MHA of 198328. Such application may be
considered in the light of Fundamental Freedoms and the Human Rights Act enforced in the year
1998 as mentioned in the case mentioned above.
Conclusion
Therefore, in the conclusion it may be said that a discussion has been forwarded in the
paper in relation to laws regarding ‘Community Treatment Orders’ and the ‘Mental Health
Tribunal’. This paper has provided an evaluation and instructions regarding William in relation
to the legality and validity in connection to his present detention. This paper has also forwarded
an advice to William in relation to any probable options that might be available to him in
connection to his discharge from the hospital. Sections such as section 2, section 3, section 5,
section 72 and section 73 has been mentioned and discussed in this paper in order to understand
the legality and validity of the detention of the patient, that is, William. Relevant cases has also
been mentioned and discussed in that regard.
27 Djaba v West London Mental Health NHS Trust [2017] EWCA Civ 436
28 Mental Health Act, 1983

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References
Cheshire West and Chester Council v P [2011] EWCA Civ 1333.
Djaba v West London Mental Health NHS Trust [2017] EWCA Civ 436.
Fundamental Freedoms and the Human Rights Act, 1998.
Jewell, Amelia, et al. "Predictors of Mental Health Review Tribunal (MHRT) outcome in a
forensic inpatient population: a prospective cohort study." BMC psychiatry 17.1 (2017): 25.
Kisely, Steve R., Leslie A. Campbell, and Richard O'Reilly. "Compulsory community and
involuntary outpatient treatment for people with severe mental disorders." Cochrane database of
systematic reviews 3 (2017).
LAURIE, GRAEME HARMON, and Edward Dove. Mason and McCall Smith's law and
medical ethics. Oxford University Press, 2019.
LCB v United Kingdom [1998] ECHR 108.
Mental Health Act, 1983.
Osman v United Kingdom (1998) 29 EHRR 245.
Powell V United Kingdom (2000) 30 EHRR CD 362.
R v. Wilson, ex parte Williamson [1996] COD 42.
Rabone v. Pennine Care NHS Foundation Trust [2012] UKSC 2.
Re: Officer L [2007] UKHL 36.
Reynolds v. United Kingdom (2012) 55 EHRR 35.

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Savage v. South Essex Partnership NHS Foundation Trust [2008] UKHL 74.
Shaw, Ian, and Hugh Middleton. Understanding Treatment Without Consent: An Analysis of the
Work of the Mental Health Act Commission. Routledge, 2016.