The rules about when the treatment of patients on supervised community treatment (SCT) has to be approved by a second opinion appointed doctor (SOAD) change on 1 June 2012. Section 299 of the Health and Social Care Act 2012 changes this aspect of the Mental Health Act 1983. The effect of the changes is that SOAD approval is generally no longer necessary if the patient is able to consent to the treatment in question.
There is a new statutory form (CTO12) to be used by the approved clinician in charge of the patient’s treatment to record that the patient has the capacity (or competence if under 16) to consent to the treatment in question and has done so. The form is introduced by The Mental Health (Hospital, Guardianship and Treatment) (England) (Amendment) Regulations 2012.
SOADs will continue to complete the current form (CTO11) when an SCT patient either does not consent or is not able to consent to the treatment.
An SCT patient who has consented may at any time withdraw that consent or could lose the capacity to consent. In either case, this will mean that a form CTO12 would no longer be valid, and a SOAD will have to record an opinion on form CTO11 instead.
Treatment may continue when a patient has lost capacity to consent, but it cannot continue against the wishes of a patient who still has capacity to consent, unless the patient is recalled to hospital. There is no legal authority to treat an SCT patient even if a SOAD has completed form CTO11.
There is no change to the rule that clinicians may not give electroconvulsive therapy (ECT) to patients under 18 without the approval of a SOAD. But they may give medication or ECT without a completed form CTO11 or CTO12 in an emergency, where it is immediately necessary.