scholarly journals Compulsory Community Treatment Orders in New Zealand and the provision of care: An examination of national databases and predictors of outcome

2021 ◽  
Vol 17 ◽  
pp. 100275
Author(s):  
Ben Beaglehole ◽  
Giles Newton-Howes ◽  
Chris Frampton
Keyword(s):  
New Zealand ◽  
Community Treatment ◽  
Predictors Of Outcome ◽  
Community Treatment Orders ◽  
Compulsory Community Treatment ◽  
National Databases ◽  
Provision Of Care

A systematic review and meta-analysis of predictors and outcomes of community treatment orders in Australia and New Zealand

2020 ◽  
pp. 000486742095428
Author(s):  
Steve Kisely ◽  
Dong Yu ◽  
Saki Maehashi ◽  
Dan Siskind
Keyword(s):  
New Zealand ◽  
Meta Analysis ◽  
Linguistically Diverse ◽  
Community Treatment ◽  
Culturally And Linguistically Diverse ◽  
Community Treatment Orders ◽  
Indigenous Status ◽  
Compulsory Community Treatment ◽  
Treatment Order ◽  
Community Treatment Order

Objectives: Australia and New Zealand have some of the highest rates of compulsory community treatment order use worldwide. There are also concerns that people from culturally and linguistically diverse backgrounds may have higher rates of community treatment orders. We therefore assessed the health service, clinical and psychosocial outcomes of compulsory community treatment and explored if culturally and linguistically diverse, indigenous status or other factors predicted community treatment orders. Methods: We searched the following databases from inception to January 2020: PubMed/Medline, Embase, CINAHL and PsycINFO. We included any study conducted in Australia or New Zealand that compared people on community treatment orders for severe mental illness with controls receiving voluntary psychiatric treatment. Two reviewers independently extracted data, assessing study quality using Joanna Briggs Institute scales. Results: A total of 31 publications from 12 studies met inclusion criteria, of which 24 publications could be included in a meta-analysis. Only one was from New Zealand. People who were male, single and not engaged in work, study or home duties were significantly more likely to be subject to a community treatment order. In addition, those from a culturally and linguistically diverse or migrant background were nearly 40% more likely to be on an order. Indigenous status was not associated with community treatment order use in Australia and there were no New Zealand data. Community treatment orders did not reduce readmission rates or bed-days at 12-month follow-up. There was evidence of increased benefit in the longer-term but only after a minimum of 2 years of use. Finally, people on community treatment orders had a lower mortality rate, possibly related to increased community contacts. Conclusion: People from culturally and linguistically diverse or migrant backgrounds are more likely to be placed on a community treatment order. However, the evidence for effectiveness remains inconclusive and limited to orders of at least 2 years’ duration. The restrictive nature of community treatment orders may not be outweighed by the inconclusive evidence for beneficial outcomes.

scholarly journals Towards Changing Compulsory Community Mental Health Treatment in New Zealand: Shining Light on How Community Treatment Orders Are Produced

Laws ◽  
2018 ◽  
Vol 7 (3) ◽  
pp. 30
Author(s):  
Alison Schneller ◽  
Katey Thom ◽  
Peter Adams
Keyword(s):  
Mental Health ◽  
New Zealand ◽  
Mental Health Treatment ◽  
Community Treatment ◽  
Health Law ◽  
Community Treatment Orders ◽  
Assemblage Theory ◽  
Health Treatment ◽  
Mental Health Law ◽  
Compulsory Community Treatment

In this paper, we use a constructed scenario to illustrate making a compulsory community treatment order in the New Zealand context. Drawing on publicly available documentation, we outline the existing mental health law framework that produces community treatment orders and emerging complex problems of their high, increasing and disproportionate use. We provide examples of human rights, indigenous and clinical effectiveness research that appear to be destabilising the existing mental health law framework. We argue assemblage theory (Deleuze & Guattari) is a useful theoretical tool to unpack the making and continued use of compulsory community treatment orders in the context of complex destabilising and stabilising influences. This is followed by an outline of the concept of assemblage with reference to the constructed scenario, focusing on processes, practices, places, types of knowledge, roles, documents and how they connect to produce certain effects that both enable and constrain participants’ actions. In the New Zealand context, we examine the potential for assemblage theory to generate new ways of thinking about compulsory mental health treatment in community settings by challenging perceived limitations and revealing opportunities for participants to act otherwise. We conclude with a proposal for further research shaped by this theory that explores the making of actual community treatment orders to reveal where there is potential to change existing relations towards more positive effects for participants.

scholarly journals Who’s Talking About Us Without Us? A Survivor Research Interjection into an Academic Psychiatry Debate on Compulsory Community Treatment Orders in Ireland

Laws ◽  
2018 ◽  
Vol 7 (4) ◽  
pp. 33 ◽  
Author(s):  
Liz Brosnan
Keyword(s):  
Human Rights ◽  
Academic Psychiatry ◽  
United Nations ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Critical Questions ◽  
Critical Issues ◽  
Compulsory Community Treatment ◽  
United Nations Convention ◽  
The United Nations

This paper presents a user/survivor researcher perspective to the debate among psychiatrists on the suggested introduction of Community Treatment Orders in Ireland. Critical questions are raised about evidence and the construction of psychiatric knowledge. Important questions include: How is this evidence created? What and whose knowledge have not been considered? Some critical issues around coercion, ‘insight’, and attributions of ‘lack of capacity’ are briefly considered. Further legal considerations are then introduced based on the United Nations Convention on the Rights of Persons with Disability. The paper concludes with a human rights-based appeal to reject the introduction of coercive community treatment in Ireland.

scholarly journals Impact of compulsory community treatment on admission rates

2004 ◽  
Vol 184 (5) ◽  
pp. 432-438 ◽  
Author(s):  
Stephen R. Kisely ◽  
Jianguo Xiao ◽  
Neil J. Preston
Keyword(s):  
Health Service ◽  
Service Use ◽  
Psychiatric Patients ◽  
Community Treatment ◽  
Health Service Use ◽  
Community Treatment Orders ◽  
Stage Design ◽  
Admission Rates ◽  
Compulsory Community Treatment ◽  
Socio Demographic Factors

BackgroundThere is controversy as to whether compulsory community treatment for psychiatric patients reduces hospital admission rates.AimsTo examine whether community treatment orders (CTOs) reduce admission rates, using a two-stage design of matching and multivariate analyses to take into account socio-demographic factors, clinical factors, case complexity and previous psychiatric and forensic history.MethodSurvival analysis of CTO cases and controls from three linked Western Australian databases of health service use, involuntary treatment and forensic history. We used two control groups: one matched on demographic characteristics, diagnosis, past psychiatric history and treatment setting, and consecutive controls matched on date of discharge from in-patient care.ResultsWe matched 265 CTO cases with 265 matched controls and 224 consecutive controls (totaln=754). The CTO group had a significantly higher readmission rate: 72%v.65% and 59% for the matched and consecutive controls (log-rank χ2=4.7,P=0.03). CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were associated with increased admission rates.ConclusionsCommunity treatment orders alone do not reduce admissions.

Do we need community treatment orders in Ireland?

2010 ◽  
Vol 27 (2) ◽  
pp. 90-96 ◽  
Author(s):  
Dermot Walsh
Keyword(s):  
Criminal Law ◽  
Convincing Evidence ◽  
Revolving Door ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
England And Wales ◽  
Inpatient Psychiatric Care ◽  
Early Introduction ◽  
Compulsory Community Treatment ◽  
Conditional Discharge

AbstractObjectives: Re-admissions to inpatient psychiatric care are now so frequent as to be designated the ‘revolving door’ phenomenon and constitute 72% of admissions to Irish inpatient psychiatric units and hospitals. It is commonly believed that treatment non-adherence with aftercare following inpatient discharge contributes to readmission. Attempts to improve adherence and reduce or shorten readmission through compulsory community treatment orders have been made in several countries including Scotland in 2005 and, from November 2008, England and Wales. Provision for conditional discharge in Ireland has already been furnished by the Criminal Law (Insanity) Act 2006 but has been compromised by the inability to impose enforcement of conditions. The paper aims to determine whether compulsory community treatment orders are effective in improving adherence and reducing re-admission and whether, in consequence, their introduction in Ireland should be considered.Method: The legislative measures adopted to improve treatment adherence and thereby reduce re-admissions are presented. The evidence of their effectiveness is examined.Results: Evaluation of the effectiveness of community treatment orders is limited and hindered by confounding factors. What evidence there is does not provide convincing evidence of their utility.Conclusions: It is concluded that there is insufficient evidence to advocate their early introduction in Ireland in civil mental health legislation. Instead a wait and see policy is suggested with critical assessment of the outcome of such developments in Scotland and England and Wales. In addition further research on the characteristics of revolving door patients in Ireland and the circumstances determining their readmission is advocated. There is an anomaly in the Criminal Law (Insanity) Act 2006 which allows of conditional discharge but does not provide for its enforcement.

scholarly journals Community treatment orders in New Zealand

2009 ◽  
Vol 6 (3) ◽  
pp. 59-60 ◽  
Author(s):  
John Dawson
Keyword(s):  
New Zealand ◽  
Psychiatric Care ◽  
Mental Healthcare ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Community Based ◽  
Community Psychiatric ◽  
Conditional Discharge ◽  
Treatment Order ◽  
Community Treatment Order

Many legal mechanisms can be used to authorise compulsory community mental healthcare: leave or conditional discharge for compulsory in-patients; adult guardianship (or incapacity) legislation; treatment as a condition of a community-based criminal sentence, like probation, or of parole from imprisonment; or a full-fledged community treatment order (CTO) scheme. It is the specific mix of mechanisms employed in a particular jurisdiction that will characterise how that legal system manages the delivery of compulsory (or quasi-consensual) community psychiatric care.

Uses of Community Treatment Orders in New Zealand: Early Findings

2001 ◽  
Vol 35 (2) ◽  
pp. 190-195 ◽  
Author(s):  
John Dawson ◽  
Sarah Romans
Keyword(s):  
New Zealand ◽  
Community Care ◽  
Significant Proportion ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Mental Health Legislation ◽  
High Level ◽  
Health Legislation ◽  
Level Of Agreement

Objective: To assess the uses of Community Treatment Orders (CommTOs) in New Zealand. Method: A retrospective study of patients' records held by the regional administrator of mental health legislation and a survey of psychiatrists attending a conference in Dunedin. Results: Males under Community Treatment Orders (CommTOs) outnumbered females 6:4; a high proportion were considered to have a major psychotic disorder; and one fifth remained under a CommTO for more than a year without inpatient care. Among the psychiatrists, there was a high level of agreement that, when used appropriately, the benefits of CommTOs outweigh their coercive impact on the patients; the most strongly supported indicator for use was the promotion of compliance with medication. The rate of use of CommTOs in Otago is remarkably similar to the rate in Victoria, Australia. Conclusions: Records suggest that a significant proportion of patients under CommTOs are not soon readmitted; and many clinicians in New Zealand consider CommTOs to be a useful strategy for managing the community care of long-term patients with schizophrenia and major affective disorders.

Maori Experience of Community Treatment Orders in Otago, New Zealand

2004 ◽  
Vol 38 (10) ◽  
pp. 830-835 ◽  
Author(s):  
Anita Gibbs ◽  
John Dawson ◽  
Hine Forsyth ◽  
Richard Mullen ◽  
Keyword(s):  
New Zealand ◽  
Community Treatment ◽  
Community Treatment Orders
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