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CTO and Forced Treatment — MRCPsych Paper B MCQ

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HardMental Health LawCTO and Forced TreatmentMRCPsych Paper B

In England, a 30-year-old man with schizophrenia is subject to a community treatment order (CTO). He has remained well for 12 months but now refuses his scheduled depot antipsychotic. He has capacity to make this treatment decision and clearly objects to the injection; there is no emergency and no current evidence of relapse or risk. His CTO includes conditions that he attend appointments and accept prescribed medication. Which statement most accurately describes the legal position?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — He cannot be given the depot forcibly in the community; recall is a separate decision requiring the statutory recall criteria.

Explanation lettering: B = shown as A · A = shown as B · E = shown as D · D = shown as E

B is correct. An unrecalled community patient who has capacity and refuses treatment cannot be given a depot forcibly in the community. A CTO condition is not directly enforceable by restraint. If the responsible clinician considers compulsory treatment necessary, recall to hospital is a separate decision and requires the statutory recall criteria; non-adherence alone does not make recall automatic. A is therefore wrong. A Part 4A certificate is a certification safeguard, not authority to override a capacitous refusal in the community, so C is wrong. There is no two-doctor mechanism permitting community restraint (D), and an AMHP cannot authorise forcible community treatment or recall (E). The narrow emergency exception applies only where the community patient lacks capacity and immediate treatment is necessary.

Reference: Royal College of Psychiatrists, “Being sectioned (in England and Wales)”, section “Can I be forced to take medication when I’m on a CTO?”, checked August 2026. https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/being-sectioned