Suspension of detention case studies

Case study 1
Ms X has an unstable mental illness that results in frequent re-admissions to hospital.  She has been detained under a compulsory treatment order. When her illness improves her detention is suspended. This never lasts long as she relapses and needs to be back in hospital for short periods. Her Responsible Medical Officer (RMO) applied for a variation to a community-based order, but had to withdraw the application because Ms X was re-admitted. She needs compulsory treatment and informal care is not possible.  Th RMO counts back and sees that she has nine months of suspension and legally no other suspension can be granted. Technically Ms X cannot be allowed out of the hospital at all.  She is better and the RMO applies for a variation.  In the meantime, what should the RMO do if suspension is not allowed?

Case study 2
Mr Y has a learning disability and is continuing in hospital care under a compulsion order because of a serious offence several years ago.  As part of his rehabilitation, the team decides he would benefit from socialisation and arrange for a member of staff to take him to the pub.  He used to enjoy a drink and alcohol was not a factor in his offence.  The care team are uncertain about whether to allow him to drink alcohol. No alcohol is allowed in the unit, other residents have alcohol related problems and the unit has imposed sanctions on other patients who drank while on leave.  Should the RMO make it a condition of his suspension that he does not drink alcohol?

Case study 3
Ms Z is in Hospital A under a short-term detention.  She is assessed as requiring treatment with ECT. In this service ECT is given in Hospital B.  She is being escorted by hospital staff at all times.  Is it necessary to suspend her detention to allow her to travel to Hospital B?  Should her care be formally transferred (twice a week) to Hospital B?  Is it necessary to document suspension of transfer at all?

 Visit the forum to participate in debate on these case studies your views, comments and ideas will help to develop good practice guidance in this area of practice.