Editing Outpatient commitment (section)

====England and Wales====
Changes in service provision and amendments to the Mental Health Act in England and Wales have increased the scope for compulsion in the community.<ref>{{Cite journal|last1=Molodynski|first1=A.|last2=Rugkasa|first2=J.|last3=Burns|first3=T.|date=2010-05-25|title=Coercion and compulsion in community mental health care|journal=British Medical Bulletin|volume=95|issue=1|pages=105–119|doi=10.1093/bmb/ldq015|pmid=20501486|issn=0007-1420|doi-access=free}}</ref> The [[Mental Health Act 2007]] introduced community treatment orders (CTOs).<ref name=MindUK/> CTOs are legally defined as a form of outpatient leave for individuals detained under section 3 of the Mental Health Act.<ref>{{cite web|last=|first=|date=|title=Mental Health Act 1983: Section 17A|url=http://www.legislation.gov.uk/ukpga/1983/20/section/17A|archive-url=|archive-date=|access-date=|website=}}</ref> As such, only members of the medical community are involved in issuing a CTO, though both the section 3 detention underlying the CTO and the CTO itself can be appealed to the [[Mental Health Tribunal]] where a panel consisting of medical doctors and a judge will make a decision.The legislation in the UK specifically allows CTOs to be issued after a single admission to hospital for treatment. However, the [[Royal College of Psychiatrists]] suggested limiting CTOs to patients with a history of noncompliance and hospitalization, when it reviewed the current mental health legislation.{{efn|name=rspych| "The remit of CTOs should be limited to ensure they are only used when most beneficial. The Review should consider amending the criteria to reflect a history of non-compliance with treatment leading to subsequent compulsory admission(s) within a defined timeframe."<ref>{{cite web|url=https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/policy/policy-rcpsych-mha-review-submission-2018.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/policy/policy-rcpsych-mha-review-submission-2018.pdf |archive-date=2022-10-09 |url-status=live|title=Review of the Mental Health Act 1983 The Royal College of Psychiatrists' submission of evidence}}</ref>}}

John Mayer Chamberlain argues that this legislation was triggered by the [[Killing of Jonathan Zito]] by an individual who had interactions with mental health services prior this event, which led the then conservative government to argue for CTOs.<ref>{{Cite book |last=Chamberlain |first=John Martyn |url=https://books.google.com/books?id=Hnn4CgAAQBAJ |title=Medicine, Risk, Discourse and Power |date=2015-11-19 |publisher=Routledge |isbn=978-1-317-33196-4 |language=en}}</ref>{{Rp|127}}

A review of patient data in London found that the average duration of a CTO in the UK was 3 years.<ref name="Barkhuizen Cullen Shetty Pritchard 2016 p.">{{cite journal | last1=Barkhuizen | first1=Wikus | last2=Cullen | first2=Alexis E | last3=Shetty | first3=Hitesh | last4=Pritchard | first4=Megan | last5=Stewart | first5=Robert | last6=McGuire | first6=Philip | last7=Patel | first7=Rashmi | title=Community treatment orders and associations with readmission rates and duration of psychiatric hospital admission: a controlled electronic case register study | journal=BMJ Open | volume=10 | issue=3 | date=2016-07-31 | pages=e035121 | pmid=32139493 | doi=10.1136/bmjopen-2019-035121 | pmc=7059496 | doi-access=free }}</ref> Black people in the UK are more than ten times as likely to be under a CTO as white people.<ref name=":0">{{Cite web|last=|first=|date=|title=Mental Health Act White Paper 2021|url=https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/951398/mental-health-act-white-paper-web-accessible.pdf|archive-url=|archive-date=|access-date=|website=}}</ref>{{Rp|13}} Concerns have been raised about the inability of Independent mental health advocates (IHMAs) to provide services to those under CTOs, since IMHAs cannot make contact with service users under CTOs and case workers could act as gatekeepers not providing referrals.<ref>{{Cite journal |last1=Weller |first1=Penelope |last2=Alvarez-Vasquez |first2=Susan |last3=Dale |first3=Matthew |last4=Hill |first4=Nicholas |last5=Johnson |first5=Brendan |last6=Martin |first6=Jennifer |last7=Maylea |first7=Chris |last8=Thomas |first8=Stuart |date=2019-09-01 |title=The need for independent advocacy for people subject to mental health community treatment orders |url=https://www.sciencedirect.com/science/article/pii/S0160252718301845 |journal=International Journal of Law and Psychiatry |language=en |volume=66 |pages=101452 |doi=10.1016/j.ijlp.2019.101452 |pmid=31706387 |s2cid=196580245 |issn=0160-2527}}</ref>{{Rp|page=6|quote=There was a concern raised over the course of the evaluation that where case managers acted as "gatekeepers", few alternatives exist for consumers to learn about and access the IMHA service.}}

In a 2021 paper reviewing the mental health act, the UK government proposed a new form of indefinite outpatient commitment allowing for deprivation of liberties an continuous supervision termed supervised discharge. This discharge would be reviewed yearly, and only apply to individuals who would not benefit from treatment in a hospital setting and would be based on risk.<ref name=":0" />{{Rp|77}} Further, this legislation would only apply to restricted patients who have been diverted to the mental health care system from courts.<ref>{{Cite web|last=|first=|date=|title=Restricted Patients 2018 - Ministry of Justice Statistics Bulletin|url=https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/796926/restricted-patients-statistical-bulletin-2018.pdf|archive-url=|archive-date=|access-date=|website=}}</ref>