Liberty or dignity: community treatment orders and rights

2013 ◽  
Vol 30 (2) ◽  
pp. 141-149 ◽  
Author(s):  
J. Lally
Keyword(s):  
Community Setting ◽  
Evidence Base ◽  
Health Needs ◽  
Community Treatment ◽  
Ethical Considerations ◽  
Community Treatment Orders ◽  
Duration Of Illness ◽  
Mental Health Legislation ◽  
Health Legislation ◽  
Robust Evidence

The use of community treatment orders (CTOs) remains controversial despite their widespread use in a number of different countries. The focus of a CTO should be on individuals with severe and enduring mental disorders, typically requiring adherence with recommended outpatient treatment in the community and requiring that they allow access to members of the clinical team for the purpose of assessment. There is no current provision for CTOs under Irish mental health legislation, although patients who are involuntarily detained under the MHA 2001 (Ireland) can be granted approved leave from hospital. This provision allows for the patient to be managed in the community setting, though, while technically on leave, they remain as inpatients detained under the MHA 2001 (Ireland). This article describes the use of CTOs and considerations relating to their implementation. There is discussion of the ethical grounds and evidence base for their use. Ethical considerations such as balancing autonomy against health needs and the utilisation of capacity principles need to be weighed by clinicians considering the use of CTOs. Though qualitative research provides some support for the use of CTOs, there remains a clear lack of robust evidence based findings to support their use in terms of hospitalisation rates, duration of illness remission and improved social functioning.

scholarly journals Community treatment orders and their use in the UK

2010 ◽  
Vol 16 (4) ◽  
pp. 260-262 ◽  
Author(s):  
Mark Taylor
Keyword(s):  
Treatment Adherence ◽  
Scientific Evidence ◽  
Health Needs ◽  
Community Treatment ◽  
Compulsory Treatment ◽  
Ethical Considerations ◽  
Community Treatment Orders ◽  
England And Wales ◽  
The Uk

SummaryDespite the lack of supportive scientific evidence, the uptake of community treatment orders (CTOs) in England and Wales since their introduction in late 2008 has been higher than expected, although there has been a relative dearth of second opinion appointed doctors. In Scotland, CTOs now constitute about 30% of all long-term civil detentions, with lack of insight and lack of treatment adherence given as the major reasons for CTO use. Ethical considerations such as balancing autonomy against health needs will continue to be weighed by clinicians considering compulsory treatment in the community.

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.

Reform or revolution? Mental health legislation and the development of community care

2020 ◽  
pp. 73-94
Author(s):  
Ian Cummins
Keyword(s):  
Mental Health ◽  
Risk Management ◽  
Civil Rights ◽  
Community Care ◽  
The Other ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Mental Health Legislation ◽  
Progressive Reforms ◽  
Health Legislation

This chapter will explore the development of mental health legislation from the introduction of the 1983 MHA to the introduction of Community Treatment Orders (CTOs) in the reforms of 2007. The chapter ends with a brief discussion of the Wessely review of the MHA that was completed in 2018. Reform of mental health legislation reflects two potentially conflicting strands. One is the state’s power to incarcerate the “mad”, the other is the move to protect the civil rights of those who are subject to such legislation. The development of legislation reflects the broader pattern of community care as a policy. The initial optimism and progressive reforms of the early 1980s are overtaken by a more managerialist, pragmatic approach which focuses on risk and risk management

scholarly journals Involuntary community treatment in New South Wales, Australia

1995 ◽  
Vol 19 (1) ◽  
pp. 45-47 ◽  
Author(s):  
John Hambridge ◽  
Nicola Watt
Keyword(s):  
Mental Health ◽  
Mentally Ill ◽  
New South ◽  
New South Wales ◽  
Community Treatment ◽  
Compulsory Treatment ◽  
Perceived Benefits ◽  
South Wales ◽  
Mental Health Legislation ◽  
Health Legislation

The New South Wales Mental Health Act (1990) heralded a number of important changes to mental health legislation in the state. One of these was the option to give compulsory treatment to mentally ill clients living in the community. This article briefly explains community treatment under the Act, and the perceived benefits and the limitations of such legislation. A case example is used to illustrate some of these points. Involuntary community treatment is seen as a less restrictive alternative to hospitalisation for a number of mentally ill clients, but the use of such provisions demands significant resources from the supervising agency.

scholarly journals Do Community Treatment Orders in Psychiatry Stand Up to Principalism: Considerations Reflected through the Prism of the Convention on the Rights of Persons with Disabilities

2019 ◽  
Vol 47 (1) ◽  
pp. 126-133 ◽  
Author(s):  
Giles Newton-Howes
Keyword(s):  
Decision Making ◽  
Psychiatric Treatment ◽  
Community Treatment ◽  
Psychiatric Practice ◽  
Individual Autonomy ◽  
Ethical Considerations ◽  
Community Treatment Orders ◽  
Persons With Disabilities ◽  
Medical Interventions ◽  
Modern Context

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.

New World of Mental Health Legislation England and Wales David Jolley and Reinhard Heun

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
D. Jolley ◽  
R. Heun
Keyword(s):  
Mental Health ◽  
Mental Disorder ◽  
Mental Illnesses ◽  
Community Treatment ◽  
List Type ◽  
Type Number ◽  
England And Wales ◽  
Use Of Resources ◽  
Mental Health Legislation ◽  
Health Legislation

After eight years of tortured negotiations between government, professional psychiatrists and lay pressure groups, England and Wales will begin to use new Mental Health Legislation November 2008. This will not be a new Mental Health Act, but a substantial modification of the 1983 act. There are nine key changes:1.A single definition of mental disorder: ‘any disorder of mind or brain’.2.Criteria for compulsion: ‘appropriate medical treatment’ test.3.Age-appropriate services: special arrangements for under 18 years.4.Professional roles: approved clinicians and responsible clinicians (non-medical).5.Nearest relative: recognises Civil Partnerships, allows displacement.6.Supervised Community Treatment Orders.7.Mental health Review Tribunal: unified.8.Advocacy: Independent Mental Health Advocates.9.ECT: new safeguards.The Code of Practice identifies five key principles:1.Purpose - to minimise adverse effects of Mental Disorder.2.Least Restriction.3.Respect - diverse needs, values and circumstances.4.Participation - involving patient in planning, developing and reviewing treatment and care.5.Effectiveness, efficiency and equity - optimal use of resources.Earlier drafts had been described as: ‘little more than a Public Oder Bill dressed up as Mental Health legislation’; ‘ethically unworkable and practically unworkable’. Much of the dissent related to suggestions that people with Personality Disorder behaving in a dangerous or antisocial way should be subject to compulsory detention. Fears included breach of liberties and Human Rights and transformation of Mental Health Services disadvantaging people with major mental illnesses.

scholarly journals Race equality, human rights and mental health legislation: Recent developments in England and Wales

2007 ◽  
Vol 13 (3) ◽  
pp. 3
Author(s):  
Lord Patel Of Bradford ◽  
Chris Heginbotham
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Mental Disorder ◽  
Community Treatment ◽  
Mental Health Legislation ◽  
Recent Developments ◽  
Definition Of ◽  
Health Legislation ◽  
Treatment Order ◽  
Community Treatment Order

<p>England now has revised mental health legislation following the passage of a mental health Bill through both Houses of Parliament following protracted discussions over seven years. The Mental Health Bill 2006, amending the Mental Health Act 1983, eventually received Royal Assent on 19 July 2007. There is much that could be said about the new Act, which makes a number of important changes to the present legislation. These changes include a new single definition of mental disorder; the abolition of the so-called ‘treatability test’; and the extension of compulsion into the community through a supervised community treatment order.</p>

Misrepresenting community treatment orders

2017 ◽  
Vol 26 (1) ◽  
pp. 38-40 ◽  
Author(s):  
John Little
Keyword(s):  
Selection Bias ◽  
Randomised Controlled Trials ◽  
Evidence Base ◽  
Community Treatment ◽  
Controlled Trials ◽  
Community Treatment Orders ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Treatment Order ◽  
Community Treatment Order

Objectives: To explore a contradiction between evidence suggesting community treatment order (CTO) ineffectiveness and clinical experience. Conclusions: The literature pertaining to CTOs actually provides an evidence base for both positions. The headline that three randomised controlled trials and subsequent meta-analyses fail to demonstrate significant differences between groups reflects selection bias. A case may still be made for CTOs.

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