mental health (care and treatment) (scotland) act 2003 code of practice volume 2 ?civil compulsory powers (parts 5, 6, 7 and 20)

chapter 4 the compulsory treatment order and the interim compulsory treatment order
in operation (part 7 chapters 2, 3 & 7or sections 72 to 76 and 127 to 129)

Introduction

This chapter outlines the processes which should be followed immediately as a consequence of a CTO or an interim CTO being made. These include, for example, the process by which an interim CTO is revoked; an RMO's duty to prepare a care plan; and the processes by which compulsory measures are suspended. It does not deal with the processes associated with formal reviews of the CTO which are examined in chapter 5 of the Code of Practice. It also does not consider the process of transferring patients subject to a CTO or an interim CTO from one hospital to another. That issue is dealt with in Chapter 14 of Volume 1. Transfers between hospitals in Scotland are dealt with in Chapter 9 of Volume 2, while Chapter 14 of Volume 1 deals with transfers into or out of Scotland.

Transferring the patient to hospital once a CTO or interim CTO has been made (section 67)

01 Section 67 of the Act relates to a patient subject to a CTO or to an interim CTO which either authorises the patient's detention in a specified hospital or imposes on the patient a requirement to reside at a specified place. If the patient needs to be transferred to the hospital or other place specified in the CTO or interim CTO, authority to do so is provided by way of section 67. This transfer under the authority of section 67 must take place within 7 days of the CTO or interim CTO being made.

02 Section 67 only authorises the patient's transfer to a hospital or other place specified in the order. It does not in itself provide an authority to detain the patient during this period. Any authority to detain the patient during this period would come from the CTO or ICTO. In any rare occasion where the patient is to be found on premises to which it is not possible to obtain entry before this transfer takes place, it may be necessary to seek a warrant under Part 19 of the Act which would authorise, for example, a police constable to enter those premises. (For further information on such warrants, see Chapter 15 of Volume 1 of the Code of Practice.)

03 Where it is thought likely that the patient will have to be removed from one place to another after the CTO is made, a contingency plan for this transfer should have been drawn up and, where practicable, presented to the Tribunal before the order is made in order to provide it with as full a view of the patient's situation as possible. Such a contingency plan, although not part of the CTO application, could be appended to the proposed care plan forming part of the CTO application.

04 It is best practice to ensure that all parties have agreed their respective roles and responsibilities in this contingency plan in advance of the transfer taking place. It would be expected that such agreement would be in line with the roles and responsibilities allocated to each group within the relevant, locally developed psychiatric emergency plan.

05 It is important to note that no formal application is required for this power. The power has effect automatically once the CTO or interim CTO is made.

Operation of an interim CTO (Part 7, Chapter 2 or sections 72 to 75)

Preparing a care plan

06 For the time that a patient is subject to an interim CTO, it would be best practice to ensure, where the length of the interim order allows, that the patient's RMO draws up and implements a care plan with respect to that patient. Such a care plan would be as near as possible to any care plan prepared under section 76 of the Act where a patient is subject to a CTO.

Reviewing and revoking an interim CTO

07 In terms of section 72 of the Act, the patient's RMO is under a duty to keep the interim CTO under constant review. The RMO must revoke the order if at any point he/she is satisfied that:

• the patient no longer meets the criteria for compulsory powers which are set out at section 64(5)(a) to (d) of the Act; or

• it is no longer necessary for the patient to be subject to the interim CTO.

08 If the RMO revokes the interim CTO, he/she must give written notice of the fact along with a statement of his/her reasons for doing so to:

• the Commission;

• the patient;

• the patient's named person;

• any guardian of the patient;

• any welfare attorney of the patient;

• the patient's MHO; and

• the Tribunal.

09 The Commission also has the power to revoke an interim CTO if it is satisfied that the criteria for compulsory powers set out at section 73(2) are no longer satisfied. Where this happens, the Commission must give written notice of the fact along with a statement of its reasons for doing so to:

• the patient's RMO;

• the patient;

• the patient's named person;

• any guardian of the patient;

• any welfare attorney of the patient;

• the patient's MHO; and

• the Tribunal.

10 The Commission and the RMO must provide any such notification as soon as is practicable after revoking the interim CTO. Although they are under a duty to provide only written notice that the interim CTO has been revoked, it would be best practice for them to ensure, where practicable, that the patient and his/her representatives are informed verbally of the revocation as soon as possible. In other words, it would be best practice to ensure that the patient does not have to wait several days for the notification letter to arrive before being made aware of the fact that the order has in fact been revoked.

11 The Act imposes a duty on the RMO under section 74(1) to send a statement of reasons for the determination. The persons who must be given the information include the patient, their named person, any guardian, any welfare attorney, the MHO and the Tribunal. It will be for the RMO to consider in the circumstances what information is needed to meet the duty to give reasons and to provide that information whilst at the same time not providing information unnecessary or irrelevant to the determination which the patient is entitled to have kept confidential.

12 It would be expected that many of the parties listed at paragraphs 8 and 9 above would have been consulted prior to the decision being taken. For example, it would be expected that the patient's MHO would have been involved in the process leading up to the revocation to ensure that the likely impact of the removal of compulsory powers on the patient's social circumstances and home situation are given due consideration and the potential impact of any decision by the patient regarding self-discharge are given due consideration. Similarly, in order to comply with the duties laid out in section 1 of the Act, regard should be had to the views of any carers the patient may have with respect to a decision to revoke the order.

13 As with the revocation of any authority to detain under this Act, it would be best practice for the RMO, with the help of other members of the patient's multi-disciplinary team, to oversee the drawing up and implementation of a discharge plan of care where the patient is being discharged from hospital. This would also apply where the patient has been subject to community-based compulsory powers.

Responsibilities and best practice subsequent to the making of a CTO

RMO responsibilities: preparing the patient's care plan (section 76)

14 The patient's RMO must prepare a care plan setting out the forms of care and treatment for the mental disorder which are currently being given to the patient and which are proposed for the duration of the CTO. This care plan will be based very largely on the proposed care plan which was submitted to the Tribunal as part of the CTO application.

15 The Mental Health (Content and amendment of care plans) (Scotland) Regulations 2005 ( SSI No. 309) ("the regulations") set out the information that must be contained in the care plan aside from the information detailed in paragraph 14 above. In general terms the regulations require that the following information must be detailed in the care plan;

(a) full details of the CTO and the day on which the order was made;

(b) the objectives of the medical treatment which it is proposed to give, and which is being given to the patient;

(c) details of any community care services or other relevant services and the objectives of those services which it is proposed to give, and which are being given to the patient;

(d) details of any other treatment, care or service (other than that described in section 76(2)(a) or in paragraph (c) above) and the objectives of that treatment, care or service which it is proposed to give, and which are being given, to the patient;

(e) the name and other appropriate contact details of the patient's responsible medical officer;

(f) the name and other appropriate contact details of the patient's mental health officer; and

(g) details of the 2 month period during which the statutory reviews under sections 77(2) or 78(2) are required to take place and the actual dates on which these reviews took place.

16 The full details of the CTO as referred to in paragraph 15(a) above would be the measures and any recorded matters authorised by the order.

17 With respect to the matters referred to in paragraph 15(g) above this simply means that when the care plan is first prepared under section 76(2) the RMO must detail on it the 2 month period during which the first statutory review must be carried out. When the first review has been carried out and the RMO is updating the care plan as mentioned in paragraph 18 below he/she must include the date on which the review took place and then detail the 2 month period during which the next statutory review must be carried out and so on.

18 The regulations also specify the circumstances in which the RMO must amend the care plan. In general terms these are where:

(a) the Tribunal has made an order with respect to the CTO;

(b) the RMO has:

• made a determination extending the CTO under section 86(1);

• granted a certificate under:

(i) section 127(1) (b) which suspends the measure of detention in the CTO;

(ii) section 128(1) (b) which suspends other measures in the CTO; which specifies a period exceeding 28 days during which the patient's CTO shall not authorise the measure or measures specified in the certificate?

• revoked under section 129(2), a certificate granted under any of the powers referred to in the bullet point above; or

• carried out any further mandatory reviews of the CTO under section 78(2).

19 This care plan should be copied for the MHO, CPN and other members of the multi-disciplinary team providing care and treatment to the patient, including community care providers. A copy should also be given to the patient and the patient's named person.

20 Although section 76 of the Act places the duty on the RMO to draw up the care plan after the CTO has been made, the MHO (and the rest of the multi-disciplinary team) should contribute fully to the preparation of the finalised and agreed care plan. The RMO should consult widely with the multi-disciplinary team in any situation where the Tribunal panel has expressed a wish to see the proposed care plan significantly altered and/or has granted different compulsory measures from those sought in the original CTO application.

Local authority responsibilities: designating an MHO (section 229)

21 The Act places a duty on the relevant local authority to designate an MHO to be responsible for the patient's case as soon as is reasonably practicable after the CTO is made. In order to provide continuity of care, it would be best practice for the local authority to ensure that, where practicable, the MHO who is designated after the making of the CTO, is the same MHO who made the CTO application. Local authorities should seek to minimise the number of changes in the designated MHO throughout the period to which the patient is subject to compulsory powers. The "relevant local authority" is defined in section 229(3) of the Act. For further information on the process of designating an MHO, see Chapter 9 of Volume 1 of the Code of Practice.

22 The designated MHO should take on the responsibility for ensuring that, as soon as is practicable after the CTO has been made, the patient and the patient's named person, independent advocate, family and carers as well as the members of the multi-disciplinary team, the relevant hospital managers and other legitimately interested parties are informed of his/her name and contact details. It would be best practice to ensure that this information is followed up in writing. The designated MHO should also ensure that, where practicable, the patient is seen in person as soon as possible after the CTO has been made. Such arrangements are particularly important in situations where:

• there has been a change of designated MHO between the application for the CTO being made and the order being made (even though such a change, as stated above, is undesirable);

• the CTO imposes community-based compulsory measures; and

• the patient was not subject to any form of compulsion immediately prior to the CTO being made.

23 It is important that the MHO's input into the patient's case does not lapse immediately or shortly after the CTO was made only to be revived at the time of a mandatory review several months later. This could necessitate, among other things, regular liaison with the patient's key workers and care managers, where appropriate. An MHO who is participating in a mandatory review of a CTO needs to have a well-informed and, preferably, first-hand view of the patient's recovery and progress since the CTO was made. The MHO should also ensure that he/she is involved with the periodic assessment and review of the care plan. This process of assessment and review could similarly be managed by way of local authority protocols. It would be best practice to ensure that the timing of this process is integrated with the RMO's responsibility to review the CTO 'from time to time'.

MHO responsibilities: preparing an SCR (section 231)

24 An MHO must prepare a Social Circumstances Report ( SCR) within
21 days of the making of the CTO. As with all other occasions on which the duty to produce an SCR arises, the MHO may decide not to produce the SCR if he/she is satisfied that it would serve little or no practical purpose. For further information on the SCR, see section 231 of the Act or Chapter 11 of Volume 1 of the Code of Practice.

What should the various parties involved in the patient's care and treatment be doing on a day-to-day basis during the operation of the CTO?

25 The various parties of the patient's multi-disciplinary team ( i.e. including voluntary sector service providers, allied health professionals, etc.) should work closely together to ensure and to monitor the provision of all the aspects of the care plan. The precise role to be played by each party in the multi-disciplinary team will necessarily be dictated by the specifics of the care plan. However, all members of the team should be fully involved in carrying out a range of duties (in addition to the duties imposed on them by the process of formally reviewing the CTO). Depending on the patient's level of need and personal circumstances, such duties could include:

• regularly exploring the continuing need for and the effectiveness of the compulsory powers granted by the Tribunal in relation to how the powers are being applied, and in relation to whether their ongoing application is justified;

• regularly exploring the extent to which the principles of the Act and other matters laid out at sections 1 to 3 of the Act are being respected; and

• keeping under regular review the extent to which the objectives of the care plan are being met and the extent to which the patient is being treated in the least restrictive environment possible.

26 All members of the patient's multi-disciplinary team should be pro-active in liaising with and reporting to one another with respect to the patient's condition. Each party should take responsibility for keeping the patient's MHO and RMO up to date with changes in the patient's condition and social circumstances. Doing so ensures that fully informed decisions can be made as to whether the CTO needs to be revoked or its compulsory measures and/or recorded matters varied. This is particularly important where the RMO and MHO do not have a substantial day-to-day involvement with the delivery of the care package. It would be best practice for reporting mechanisms and practices to be reviewed regularly by the patient's MHO and RMO.

Suspending the compulsory measures specified in a CTO or an ICTO (sections 127 to 129)

27 The patient's RMO can suspend any of the compulsory measures specified in a CTO. He/she can also suspend the hospital detention requirement specified in an ICTO. Section 127 of the Act, as amended by The Mental Health (Care and Treatment (Scotland) Act 2003 (Modifications of Enactments) Order 2005, of the Act and paragraphs 28 to 50 of this chapter deal with the suspension of the requirement to detain the patient in hospital. Section 128 and paragraphs 51 to 56 of this chapter examine the suspension of any of the other compulsory measures specified in a CTO. Finally, paragraphs 57 to 61 examine the issue of revoking a suspension certificate which is addressed in the Act at section 129.

Suspension of hospital detention requirement where a patient is subject to a CTO or an ICTO (section 127)

28 Where a patient is subject to a CTO or an ICTO which specifies that the patient be detained in hospital, it is possible to suspend that hospital detention requirement for a limited period of time (and thereby suspend the patient's detention in hospital) without revoking the order in its entirety. Under such circumstances, section 127(1) of the Act allows for a "suspension certificate" to be granted. Such a certificate can only be granted by the patient's RMO.

How long does a suspension certificate last?

29 In terms of section 127(1) of the Act, the suspension certificate can last for any period of time as long as this period is not greater than 6 months if the patient is subject to a CTO. Where the patient is subject to an ICTO, the suspension certificate can last for any period of time, in terms of section 127(3), as amended, of the Act. In both cases, the expiry date of the suspension certificate must not go beyond the proposed expiry date of the CTO or the ICTO. In terms of section 127(4), the period specified in a suspension certificate may be the duration of an event or series of events with or without any associated travel.

30 There are additional considerations with respect to timescales where a patient is subject to a CTO. The RMO may not grant a suspension certificate if the period authorised in that suspension certificate, when taken together with any other suspension certificate granted in respect of that patient, would be greater than 9 months within the 12 month period which would end with the expiry of the proposed suspension certificate. This is to prevent a patient being subject to suspension certificates for unnecessarily long periods of time.

Can conditions be attached to the suspension certificate?

31 Yes. The patient's RMO may by virtue of section 127(5) and (6) of the Act attach certain conditions to the certificate irrespective of whether the patient is subject to a hospital-based CTO or ICTO. These conditions are:

• that the patient be kept in the charge of a person authorised in writing for that purpose by the patient's RMO; and

• any other conditions as may be specified by the patient's RMO.

32 The reasons which must motivate the attaching of conditions to a suspension certificate are set out in section 127(5) of the Act. They are that:

• it is necessary in the interests of the patient to do so; or

• it is necessary for the protection of any other person to do so.

33 It should be noted that the RMO's giving of authority to another person to keep a patient in his/her charge can only be done in writing.

34 Examples of conditions which could be attached to a suspension certificate include that the patient live in a specified place under the care of a specified person; be kept in the charge of an escorting nurse; or that the patient accept visits from a medical practitioner or an MHO. It would be best practice for the RMO to ensure that the patient's MHO and other members of the multi-disciplinary team are informed of any conditions attached to the suspension certificate, and to ensure that procedures and contingency plans are put in place for any occasion where the conditions are not complied with.

35 When attaching conditions to a suspension certificate, the patient's RMO should also consider the extent to which it would be more appropriate to make an application to the Tribunal under section 95 of the Act seeking a variation of the CTO.

When would it be appropriate to grant a suspension certificate?

36 A suspension certificate suspending the hospital detention requirement could be granted for a number of reasons including a compassionate visit or emergency treatment in another hospital, as described below. Its main purpose, however, will be to act as a tool in the process of planning a patient's discharge from compulsory measures and, more generally, from in-patient psychiatric services. For example, a suspension certificate could be granted to allow the patient to visit and/or be assessed in a place likely to be providing a community care service; or to allow the patient to be gradually re-integrated into their pre-existing social circumstances in the community. This could include allowing the patient to make visits to home or to stay overnight at home, with relatives and carers, or in other care facilities.

37 The patient's RMO should give full consideration to the need for a multi-disciplinary assessment of the impact on health and welfare of the patient and others, of the proposed stay in the community. Any proposed suspension of detention and its objectives should concord fully with the patient's agreed care plan and its objectives. In coming to a conclusion on the appropriateness of the proposed suspension certificate, it will be vitally important that the RMO involve the patient's MHO and other members of the multi-disciplinary team fully. All practitioners involved in this process should also have regard to the principles of the Act and other matters laid out in sections 1 to 3, when deciding whether or not to grant a suspension certificate. Particularly important among these principles, is the principle stated at section 1(4) of the Act which provides for any person discharging a function under the Act to discharge that function in a manner which "involves the minimum restriction on the freedom of the patient that is necessary in the circumstances".

38 It would be expected that the patient and the patient's named person be as fully involved as possible with the planning process preceding the decision to grant a suspension certificate. Subject to the patient's consent, detailed prior consultation will also need to take place with any appropriate relatives or friends of the patient (particularly where the patient is to reside with them once no longer detained in hospital) and with relevant community service providers. It would be best practice not to grant a suspension certificate where the patient does not consent to relatives or friends being consulted, where they are to be involved in his/her care once no longer in hospital.

39 The patient's RMO, in consultation with the patient's multi-disciplinary team, will need to give careful consideration to whether the compulsory measures specified in a patient's CTO should in fact be varied under section 95 of the Act rather than temporarily suspended, before taking the final decision to grant a suspension certificate. While there will undoubtedly be occasions when it is appropriate to grant a suspension certificate as a means of assessing the patient's likely recovery in a community environment rather than in a hospital, a suspension certificate should not be granted merely as a means of avoiding the need to make a section 95 application to the Tribunal to vary a CTO or of avoiding discharging the patient from compulsory measures altogether. For example, attaching a condition to a suspension certificate which stipulates that the patient reside at a specified place should not be used as a long-term alternative to applying to the Tribunal for an order which would vary a previously hospital-based CTO to a community-based CTO which specifies a residence requirement. Accordingly, a suspension certificate and the extent to which it is meeting its objectives should be kept under constant review by the patient's multi-disciplinary team with a view either to revoking the CTO or to making an application to the Tribunal to vary the compulsory measures specified in the order as soon as either option becomes appropriate.

40 Particular consideration should be given to the need for an application under section 95 of the Act where any of the conditions attached to the suspension certificate are equivalent to any community-based compulsory measures which were not discussed and considered by the Tribunal when the CTO was first made.

41 The decision as to whether to proceed with the granting of a suspension certificate as an alternative to an application under section 95 of the Act will ultimately depend on the extent to which the multi-disciplinary team is confident that the patient is ready to be discharged to the community. If the multi-disciplinary team have reservations about the patient's readiness to be discharged, it would be appropriate to grant a suspension certificate which would make the patient's stay in the community subject to an early review. Such a review should be undertaken sooner rather than later after the suspension certificate was granted with a view to making a section 95 application to the Tribunal.

42 A suspension certificate should only be granted under sections 127 or 128 of the Act where it accords with the assessed needs of the patient and not as a means of managing beds in wards which are running at or above capacity. A decision to suspend the power to detain a patient in hospital should only be taken where it is in the best interests of the patient.

Who is responsible for the patient's care and treatment while subject to a suspension certificate?

43 The patient's RMO remains responsible for the patient's care and treatment while the patient is subject to a suspension certificate. He/she must therefore ensure that appropriate arrangements are made for the patient's care and treatment while not in hospital. It should also be remembered that the duty under section 1(6) of the Act to provide "appropriate services" to the patient includes any time where the patient is subject to a suspension certificate.

44 It is important that the patient's relatives and carers (especially where the patient is residing with them for the duration of the suspension certificate) and all the members of the patient's multi-disciplinary team should have clear lines of communication with the patient's RMO so that the patient's progress towards recovery can be effectively monitored and acted upon, where appropriate.

45 Where the duration of the suspension certificate is fairly lengthy (for example, for more than 28 days), it would be best practice for the patient's RMO to issue a written reminder to the patient to return to hospital shortly before the period of suspension is due to end. If the patient does not return on time, then he/she can be said to have absconded and may be dealt with in terms of Part 20 of the Act.

Who must be notified prior to the granting of a suspension certificate?

46 There are a range of notification procedures attached to the granting of a suspension certificate under section 127 of the Act. These are set out in subsections (7) to (9) of that section. If the hospital detention requirement is to be suspended for a period of more than 28 days, the RMO must give notice of the proposal to suspend the CTO to the following parties:

• the patient

• the patient's named person;

• the patient's general medical practitioner; and

• the patient's mental health officer.

47 It should be noted that the RMO must provide notification to these parties before the suspension certificate under section 127(1) is granted. The RMO must additionally give notice to the Commission of the granting of a suspension certificate specifying a period of more than 28 days within 14 days of it being granted.

48 It would be best practice to ensure that these parties receive similar notifications where a suspension period of less than 28 days is proposed.

What should happen where a patient requires emergency treatment in another hospital?

49 There may be rare occasions where a patient who is detained in hospital on the authority of a CTO or an ICTO requires to be transferred urgently to another hospital to receive emergency treatment for a physical disorder. If there is insufficient time in such circumstances to effect a formal transfer of the patient under Part 7, Chapter 6 of the Act, it would be permissible to grant a suspension certificate suspending the hospital detention requirement of the CTO or the ICTO as this would allow the transfer of the patient to take place urgently. It should be remembered, however, that the patient could not be detained in the second hospital ( i.e. the patient could not be prevented from leaving that hospital) given that the first hospital will be explicitly specified in the CTO. The patient could only be detained in the second hospital where the patient's RMO has explicitly cited residence in the second hospital as a condition of the suspension certificate.

50 Best practice would suggest that the RMO should take steps to ensure that the patient's named person, primary carer, MHO and other relevant members of the multi-disciplinary team are informed of any emergency transfer as soon as possible after it becomes apparent that the transfer may be necessary.

Can a suspension certificate be granted with respect to compulsory measures other than the hospital detention requirement? (section 128)

51 Yes. Section 128 of the Act permits the patient's RMO to grant a suspension certificate suspending any compulsory measure specified in a CTO other than the hospital detention requirement. Compulsory measures other than the hospital detention requirement cannot be suspended where the patient is subject to an ICTO.

52 It should also be noted that a patient's RMO cannot attach conditions to a suspension certificate granted under section 128. This is in contrast to a suspension certificate granted under section 127 which suspends the hospital detention requirement where the patient is subject to a CTO or an ICTO.

53 The reasons for granting such a suspension certificate will be similar to those motivating the granting of a suspension certificate which suspends the hospital detention requirement of a CTO or ICTO. For further information on this point, see paragraphs 31 to 35 of this chapter.

54 A suspension certificate granted under section 128(1) of the Act may not last longer than 3 months. The RMO may not grant a suspension certificate if the period authorised in that certificate, when taken together with any other suspension certificate suspending compulsory measures other than the hospital detention requirement, would be greater than 3 months.

55 Before granting a suspension certificate under section 128(1) of the Act, in terms of section 128(4), the patient's RMO must notify the following parties of the compulsory measures to be suspended; the period for which they are to be suspended; and the RMO's reasons for suspending them. The parties to be notified are:

• the patient;

• the patient's named person; and

• the patient's mental health officer.

56 The RMO must provide notification to these parties before the suspension certificate is granted under section 128(1). In terms of section 128(5), the RMO must additionally within 14 days of the suspension certificate being granted, give notice to the Commission of the granting of the certificate; the measures suspended by the certificate and the period for which they are to be suspended; and the RMO's reasons for suspending those measures. It would always be best practice to ensure that any such notifications are provided as soon as possible after the duty to provide them arises.

Can a suspension certificate be revoked?

57 Any suspension certificate granted under sections 127(1), 127(3) or 128(1) of the Act can be revoked by the patient's RMO under section 129 if he/she is satisfied that it is necessary in the interests of the patient to do so or that it is necessary for the protection of any other person to do so.

58 In terms of section 129(3), as soon as practicable after revoking a certificate which suspended the hospital detention requirement of a CTO or ICTO, the RMO must notify the following parties of the revocation. The parties are:

• the patient;

• the patient's named person;

• the patient's mental health officer;

• any person who was authorised to keep the patient in their charge during the period authorised by the suspension certificate; and

• the patient's general medical practitioner.

59 It would be expected, however, that the RMO discuss with the patient and the other parties mentioned in the preceding paragraph any possible revocation of the suspension certificate before the certificate is suspended. The RMO should, for example, consider very carefully the reasons for revoking the certificate and, in particular, the effects this revocation might have on the patient's recovery.

60 In terms of section 129(4), as soon as practicable after revoking a suspension certificate which suspended any compulsory measure specified in a CTO other than the hospital detention requirement, the RMO must notify the following parties of the revocation and of the reasons for revoking it. The parties are the patient; the patient's named person; and the patient's mental health officer.

61 Where any suspension certificate is revoked, the patient's RMO must notify the Commission of the revocation within 14 days of it having taken place in terms of section 129(5).