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Consultant psychiatrists' experiences of using supervised discharge

Results of a national survey

Department of Clinical Psychology, University of Leeds, 15 Hyde Terrace, Leeds LS2 9JT

Vanessa Pinfold, Project Coordinator, Jonathan Bindman, Clinical Lecturer and Graham Thornicroft, Professor of Community Psychiatry

Institute of Psychiatry, De Crespigny Park, London SE5 8AF; tel.: 020 78480714; fax: 020 72771462

See pp. 401-402, this issue.

AIMS AND METHOD

Supervised discharge orders (SDOs) enable a degree of compulsion to be exerted over patients in the community. We aimed to establish the level of, and reasons for, their use and consultants' perceptions of their effectiveness. All mental health provider NHS trusts in England were surveyed, and a random sample cohort of cases was identified. Community responsible medical officers (CRMOs) were surveyed using a semi-structured questionnaire.

RESULTS

We identified 596 cases subject to SDOs in 170 mental health provider trusts (100%) in England, involving 18% of consultant psychiatrists. Responses were obtained from the CRMOs of 185 patients (84%) from a sample of 221 cases. The SDO was described as helpful or very helpful in 77% of cases in which it had been in place for over 2 months. In 58% of cases the SDO was intended to improve medication compliance, and in 46% of these cases it was perceived to be effective in doing so.

CLINICAL IMPLICATIONS

SDOs are not widely used in England. However, for those patients who are made subject to supervised discharge, the order appears to be effective and may improve medication compliance, despite the absence of the legal power to enforce treatment.

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