Community powers under the Mental Health Act: care or control?

District Nursing Sister Janet Jones had been visiting a young patient, Peter James, 20, at his bedsit on a weekly basis to assist him with the management of his diabetes. However some 6 months ago Peter stopped eating and began refusing to take his insulin because he believed that they had been contaminated by alien dust. Sister Jones and the GP also noticed that Peter was drinking considerable quantities of alcohol and there were reports of him engaging in bizarre sexual rituals. Concern about Peter's mental health and refusal of treatment resulted in him being detained under the Mental Health Act 1983. Sister Jones has now received a request from the mental health unit to visit Peter at his home during a period of leave he has been granted by his responsible medical officer (RMO) and to continue visiting as part of his aftercare arrangements when he is discharged. Sister Jones wonders if the mental health team will be able to manage Peter in the community given his previous reluctance to accept treatment and how Peter will afford the aftercare package of home care support and meals on wheels provided by the local authority.