Section 22 of the Act amends section 17A of the 1983 Act to require the community clinician responsible for overseeing the patient’s care as a community patient, to be involved in decisions regarding the use and operation of community treatment orders (CTOs). This covers the decision to make a person subject to a CTO, to vary or suspend conditions made under a CTO, to recall to hospital a patient subject to a CTO, and to revoke a CTO after a patient has been so recalled.
	In introducing a further professional opinion and check on whether people really need the support of a CTO and in requiring more evidence that a person otherwise presents a risk, or needs the CTO to support a benefit to their mental health, the principle of least restriction and therapeutic benefit is supported.
	The section makes a new distinction between a patient’s responsible clinician with overall responsibility for them including in hospital, and a community clinician, with the responsibility for the patient in the community, and the section imposes specific duties on the latter, where the community clinician is not the responsible clinician. Section 22 subsection (7) amends section 34(1) (interpretation of Part 2) of the 1983 Act in order to provide a definition of the community clinician as the approved clinician (as defined in section 145 subsection (1) of the 1983 Act) overseeing the patient’s care as a community patient, or who would oversee the patient’s care if they were to become a community patient.
	Subsection (2) amends section 17A(4) of the 1983 Act, to require that, where the responsible clinician is not the clinician who will have care for the patient in the community after discharge, then that community clinician must also agree in writing that the CTO criteria are met. This achieves two aims – continuity of care of the patient from the hospital into the community and additional professional oversight.
	Subsection (3)(a) amends section 17B(2) of the 1983 Act so that a CTO may only specify conditions with the agreement of the community clinician, in addition to the AMHP, as is currently required under section 17B(2).
	Subsection (3)(b) inserts new subsection 17B(5A), which adds a new requirement that a patient’s responsible clinician must consult a community clinician who has been involved with the patient’s medical treatment in the community, unless the responsible clinician has so been involved, before varying or suspending conditions made as part of a CTO, unless consultation would involve unreasonable delay. The intention is that the opinion of a community clinician is considered in these circumstances by the hospital responsible clinician.
	Subsection (4) inserts new subsection 17E(2A) in relation to recalls to require that where the responsible clinician is not the community clinician, before a responsible clinician recalls a patient under a CTO to hospital to provide medical treatment for medical disorder or to manage a risk of harm to the patient or others, they must first consult the community clinician unless consultation would involve unreasonable delay.
	Subsection (5) inserts new subsection 17F(4A) to require that, after a patient has been recalled to hospital, and before a responsible clinician revokes the CTO to place the patient back on a hospital section, they must first consult the community clinician unless consultation would involve unreasonable delay.
	Subsection (6) makes amendments to section 20A to require that, when extending a patient’s CTO period, the responsible clinician, if they are not the community clinician, must secure a statement in writing from the community clinician that they are satisfied that the CTO criteria in section 20(A)6 are satisfied.
	Subsections (8) and (9) amend section 80C (removal of patients subject to compulsion in the community from Scotland) and section 85ZA (responsibility for community patients transferred from Channel Islands or Isle of Man) of the 1983 Act. Currently, these sections state that as soon as practicable after the patient's arrival at the place where they are to reside in England or Wales, the responsible clinician shall specify the conditions to which they are to be subject to the CTO. Subsections (8), (9) and (10) add that that these conditions must be that which the approved mental health professional (AMHP), as currently, and community clinician have agreed should be specified.
Community treatment orders Section 22: Consultation of the community clinician