The legal oversight of community treatment orders: A qualitative analysis of tribunal decision-making

Compulsory psychiatric treatment is the norm in many Western countries, despite the increasingly individualistic and autonomous approach to medical interventions. Community Treatment Orders (CTOs) are the singular best example of this, requiring community patients to accept a variety of interventions, both pharmacological and social, despite their explicit wish not to do so. The epidemiological, medical/treatment and legal intricacies of CTOs have been examined in detail, however the ethical considerations are less commonly considered. Principlism, the normative ethical code based on the principles of autonomy, beneficence, non-maleficence and justice, underpins modern medical ethics. Conflict exists between patient centred commentary that reflects individual autonomy in decision making and the need for supported decision making, as described in the Convention on the Rights of Persons with Disabilities (CRPD) and the increasing use of such coercive measures, which undermines this principle. What appears to have been lost is the analysis of whether CTOs, or any coercive measure in psychiatric practice measures up against these ethical principles. We consider whether CTOs, as an exemplar of coercive psychiatric practice, measures up against the tenets of principalism in the modern context in order to further this debate.

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Decision-Making in Community Treatment Orders: A Comparison of Clinicians and Mental Health Review Board Members

Australasian Psychiatry ◽

10.1046/j.1440-1665.2002.00388.x ◽

2002 ◽

Vol 10 (1) ◽

pp. 29-32 ◽

Cited By ~ 5

Author(s):

Sol Jaworowski ◽

Rumiana Guneva

Keyword(s):

Mental Health ◽

Decision Making ◽

Community Treatment ◽

Board Members ◽

Community Treatment Orders ◽

Health Review

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Community Treatment Orders and Supported Decision-Making

Frontiers in Psychiatry ◽

10.3389/fpsyt.2019.00414 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 2

Author(s):

Lisa Brophy ◽

Renata Kokanovic ◽

Jacinthe Flore ◽

Bernadette McSherry ◽

Helen Herrman

Keyword(s):

Decision Making ◽

Community Treatment ◽

Community Treatment Orders

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The use of community treatment orders in competent patients is not justified

The British Journal of Psychiatry ◽

10.1192/bjp.bp.116.193920 ◽

2017 ◽

Vol 210 (5) ◽

pp. 311-312 ◽

Cited By ~ 10

Author(s):

Giles Newton-Howes ◽

Christopher James Ryan

Keyword(s):

Decision Making ◽

Human Rights ◽

Empirical Evidence ◽

Community Treatment ◽

Necessary Condition ◽

Community Treatment Orders ◽

Decision Making Capacity

SummaryEmpirical evidence for the effectiveness of community treatment orders (CTOs) is at best mixed. We examine CTOs through the prism of human rights and discrimination, bearing the evidence in mind, and argue that a necessary condition for their use is that a person lacks decision-making capacity.

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Community treatment orders in England and Wales: national survey of clinicians' views and use

The Psychiatrist ◽

10.1192/pb.bp.110.032631 ◽

2011 ◽

Vol 35 (9) ◽

pp. 328-333 ◽

Cited By ~ 26

Author(s):

Catherine Manning ◽

Andrew Molodynski ◽

Jorun Rugkåsa ◽

John Dawson ◽

Tom Burns

Keyword(s):

Decision Making ◽

National Survey ◽

Royal College ◽

Research Evidence ◽

Response Rate ◽

Community Treatment ◽

Clinical Implications ◽

Community Treatment Orders ◽

England And Wales ◽

And Training

Aims and methodTo ascertain the views and experiences of psychiatrists in England and Wales regarding community treatment orders (CTOs). We mailed 1928 questionnaires to members of the Royal College of Psychiatrists.ResultsIn total, 566 usable surveys were returned, providing a 29% response rate. Respondents were generally positive about the introduction of the new powers, more so than in previous UK studies. They reported that their decision-making regarding compulsion was based largely on clinical grounds.Clinical implicationsIn the absence of research evidence or a professional consensus about the use of CTOs, multidisciplinary input in decision-making is essential. Further research and training are urgently needed.

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Community Treatment Orders: a qualitative investigation of patient experiences in England

Psychiatrische Praxis ◽

10.1055/s-0031-1277839 ◽

2011 ◽

Vol 38 (S 01) ◽

Author(s):

J Rugkåsa ◽

K Canvin

Keyword(s):

Patient Experiences ◽

Community Treatment ◽

Qualitative Investigation ◽

Community Treatment Orders

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Analisa Pengaruh Motivasi Konsumen, Persepsi Kualitas, Dan Sikap Konsumen Terhadap Keputusan Pembelian Sepeda Motor PT. Yamaha Indonesia MFG

CICES ◽

10.33050/cices.v5i2.619 ◽

2019 ◽

Vol 5 (2) ◽

pp. 188-203

Author(s):

Ria Wulandari ◽

M. Ifran Sanni ◽

Dani Ramadhan

Keyword(s):

Decision Making ◽

Regression Analysis ◽

Qualitative Analysis ◽

Purchase Decisions ◽

Analysis Method ◽

Purchasing Decisions ◽

Processing Data ◽

Customer Purchases ◽

Customer Attitudes ◽

Quantitative And Qualitative Methods

This research is motivated by a decline in motorcycle sales produced by PT. Yamaha Indonesia MFG in the 2014-2018 period. In this research there was a decrease in the decision on the power of interest in customer purchases on PT. Yamaha Indonesia MFG so that later can be analyzed in the formulation of this paper, that how customer take motorcycle purchase decisions amid the phenomenon of competition and increasingly crowded sales rivalries. The purpose of this research was to analyze the influence of motivation, perceived quality, and customer attitudes toward decisions in purchasing Yamaha motorbikes. This research uses quantitative and qualitative methods. The respondents in this research were 100 people who could meet one to five criteria consisting of; initiator (initiator), influencer (influencer), decision making (decider), purchase (buyer), user (user) motorcycle production PT. Yamaha Indonesia MFG. There are 3 hypotheses formulated and tested using the Regression Analysis method. In qualitative analysis it is obtained from the interpretation of processing data by providing information and explanation. In the results of this research shows the results of Motivation, Quality Perception, and Customer Attitudes have a relationship that has a significant impact on Purchasing Decisions.

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Deriving Effective Decision-Making Strategies of Prosthetists: Using Hidden Markov Modeling and Qualitative Analysis to Compare Experts and Novices

Human Factors The Journal of the Human Factors and Ergonomics Society ◽

10.1177/00187208211032860 ◽

2021 ◽

pp. 001872082110328

Author(s):

Pratima Saravanan ◽

Jessica Menold

Keyword(s):

Decision Making ◽

Qualitative Analysis ◽

Clinical Decision Making ◽

Hidden Markov ◽

Activity Level ◽

Markov Modeling ◽

Support Tool ◽

Case Complexity ◽

Hidden Markov Modeling ◽

Expert And Novice

Objective This research focuses on studying the clinical decision-making strategies of expert and novice prosthetists for different case complexities. Background With an increasing global amputee population, there is an urgent need for improved amputee care. However, current prosthetic prescription standards are based on subjective expertise, making the process challenging for novices, specifically during complex patient cases. Hence, there is a need for studying the decision-making strategies of prosthetists. Method An interactive web-based survey was developed with two case studies of varying complexities. Navigation between survey pages and time spent were recorded for 28 participants including experts ( n = 20) and novices ( n = 8). Using these data, decision-making strategies, or patterns of decisions, during prosthetic prescription were derived using hidden Markov modeling. A qualitative analysis of participants’ rationale regarding decisions was used to add a deep contextualized understanding of decision-making strategies derived from the quantitative analysis. Results Unique decision-making strategies were observed across expert and novice participants. Experts tended to focus on the personal details, activity level, and state of the residual limb prior to prescription, and this strategy was independent of case complexity. Novices tended to change strategies dependent upon case complexity, fixating on certain factors when case complexity was high. Conclusion The decision-making strategies of experts stayed the same across the two cases, whereas the novices exhibited mixed strategies. Application By modeling the decision-making strategies of experts and novices, this study builds a foundation for development of an automated decision-support tool for prosthetic prescription, advancing novice training, and amputee care.

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