Clinical stability in the community associated with long-term approved leave under the Mental Health Act 2001

2014 ◽  
Vol 31 (2) ◽  
pp. 143-148 ◽  
Author(s):  
E. Bainbridge ◽  
F. Byrne ◽  
B. Hallahan ◽  
C. McDonald
Keyword(s):  
Mental Health ◽  
Case Report ◽  
Community Treatment ◽  
Residential Setting ◽  
Community Treatment Orders ◽  
Psychotic Illness ◽  
Persistent Symptoms ◽  
Mental Health Act ◽  
Clinical Stability

IntroductionWe present the case of a 27-year-old man with a background diagnosis of treatment resistant schizophrenia and absent insight who for the last 3 years has been residing in a high support residential setting on approved leave under the Mental Health Act (MHA) 2001. The case demonstrates how this man achieved clinical stability in the community with the assistance of long-term involuntary admission under the MHA 2001, in contrast to the previous years of his illness in which he had suffered multiple relapses of his psychotic illness with ssociated distress, poor self-care and repeated in-patient re-admissions. We discuss the equivalent use of community treatment orders in other jurisdictions and how the judicious use of approved leave under the MHA 2001 may be used as an alternative in Ireland where community treatment orders are not currently available.MethodCase Report.ConclusionThe case report highlights how the use of long-term approved leave under the MHA2001 may be used as alternative in Ireland to mimic CTOs for certain difficult to treat patients with psychotic illness who would benefit from ongoing treatment, but lack capacity to engage in such treatment due to persistent symptoms and lack of insight.

scholarly journals This strange republic of the good: Community treatment orders and their conditions

2014 ◽  
pp. 39 ◽  
Author(s):  
David Hewitt
Keyword(s):  
Mental Health ◽  
Health Professional ◽  
Mental Health Professional ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Mental Health Act ◽  
Treatment Order ◽  
Community Treatment Order

The Community Treatment Order (CTO) was introduced by the Mental Health Act  2007, and from the start, it was controversial. There is evidence that even the principle of community compulsion was opposed by a majority of psychiatrists, and it was said that many would resign rather than implement CTOs. Happily, that prediction has not been realised. In fact, it seems that many psychiatrists, and more than one Approved Mental Health Professional (AMHP), have seized upon CTOs with something approaching alacrity.

scholarly journals Impact of introducing capacity-based mental health legislation on the use of community treatment orders in Norway: case registry study

BJPsych Open ◽  
2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Georg Høyer ◽  
Olav Nyttingnes ◽  
Jorun Rugkåsa ◽  
Ekaterina Sharashova ◽  
Tone Breines Simonsen ◽  
...  
Keyword(s):  
Mental Health ◽  
Incidence Rates ◽  
Community Treatment ◽  
Prevalence Rates ◽  
Community Treatment Orders ◽  
Retrospective Case ◽  
Case Register ◽  
Mental Health Act ◽  
Catchment Areas ◽  
Involuntary Care

Background In 2017, a capacity-based criterion was added to the Norwegian Mental Health Act, stating that those with capacity to consent to treatment cannot be subjected to involuntary care unless there is risk to themselves or others. This was expected to reduce incidence and prevalence rates, and the duration of episodes of involuntary care, in particular regarding community treatment orders (CTOs). Aims The aim was to investigate whether the capacity-based criterion had the expected impact on the use of CTOs. Method This retrospective case register study included two catchment areas serving 16% of the Norwegian population (aged ≥18). In total, 760 patients subject to 921 CTOs between 1 January 2015 and 31 December 2019 were included to compare the use of CTOs 2 years before and 2 years after the legal reform. Results CTO incidence rates and duration did not change after the reform, whereas prevalence rates were significantly reduced. This was explained by a sharp increase in termination of CTOs in the year of the reform, after which it reduced and settled on a slightly higher leven than before the reform. We found an unexpected significant increase in the use of involuntary treatment orders for patients on CTOs after the reform. Conclusions The expected impact on CTO use of introducing a capacity-based criterion in the Norwegian Mental Health Act was not confirmed by our study. Given the existing challenges related to defining and assessing decision-making capacity, studies examining the validity of capacity assessments and their impact on the use of coercion in clinical practice are urgently needed.

scholarly journals Community treatment orders and associations with readmission rates and duration of psychiatric hospital admission: a controlled electronic case register study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e035121 ◽  
Author(s):  
Wikus Barkhuizen ◽  
Alexis E Cullen ◽  
Hitesh Shetty ◽  
Megan Pritchard ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Mental Health ◽  
Mortality Rate ◽  
Psychiatric Hospital ◽  
Mental Healthcare ◽  
Index Admission ◽  
Community Treatment ◽  
Lower Mortality ◽  
Community Treatment Orders ◽  
Electronic Health Record Data ◽  
Mental Health Act

ObjectivesLimited evidence is available regarding the effect of community treatment orders (CTOs) on mortality and readmission to psychiatric hospital. We compared clinical outcomes between patients placed on CTOs to a control group of patients discharged to voluntary community mental healthcare.Design and settingAn observational study using deidentified electronic health record data from inpatients receiving mental healthcare in South London using the Clinical Record Interactive Search (CRIS) system. Data from patients discharged between November 2008 and May 2014 from compulsory inpatient treatment under the Mental Health Act were analysed.Participants830 participants discharged on a CTO (mean age 40 years; 63% male) and 3659 control participants discharged without a CTO (mean age 42 years; 53% male).Outcome measuresThe number of days spent in the community until readmission, the number of days spent in inpatient care in the 2 years prior to and the 2 years following the index admission and mortality.ResultsThe mean duration of a CTO was 3.2 years. Patients receiving care from forensic psychiatry services were five times more likely and patients receiving a long-acting injectable antipsychotic were twice as likely to be placed on a CTO. There was a significant association between CTO receipt and readmission in adjusted models (HR: 1.60, 95% CI 1.42 to 1.80, p<0.001). Compared with controls, patients on a CTO spent 17.3 additional days (95% CI 4.0 to 30.6, p=0.011) in a psychiatric hospital in the 2 years following index admission and had a lower mortality rate (HR: 0.66, 95% CI 0.50 to 0.88, p=0.004).ConclusionsMany patients spent longer on CTOs than initially anticipated by policymakers. Those on CTOs are readmitted sooner, spend more time in hospital and have a lower mortality rate. These findings merit consideration in future amendments to the UK Mental Health Act.

scholarly journals Personality disorder and the Mental Health Act 1983 (amended)

2010 ◽  
Vol 16 (5) ◽  
pp. 329-335
Author(s):  
Piyal Sen ◽  
Ashley Irons
Keyword(s):  
Mental Health ◽  
Personality Disorder ◽  
Community Treatment ◽  
The Political ◽  
Specific Reference ◽  
Political Climate ◽  
Community Treatment Orders ◽  
Usual Practice ◽  
Mental Health Act ◽  
Definition Of

SummaryThe Mental Health Act 1983 now incorporates amendments introduced in 2007. This article explores features of the amended Act that affect the treatment of patients with personality disorder in England and Wales. It discusses issues such as the broad definition of mental disorder, treatability and professional roles, with specific reference to how they might, or might not, affect usual practice concerning patients with personality disorder. It also comments on elements within the Act that could positively affect people with personality disorder, such as community treatment orders, provision to change their ‘nearest relative’ and statutory advocacy services. The political climate in which the Act has been amended is commented on, as well as how this might potentially compromise some of the positives within the Act.

scholarly journals Does legislative change affect the use and duration of compulsory treatment orders?

2018 ◽  
Vol 53 (5) ◽  
pp. 433-440 ◽  
Author(s):  
Ruth Vine ◽  
Holly Tibble ◽  
Jane Pirkis ◽  
Fiona Judd ◽  
Matthew J Spittal
Keyword(s):  
Mental Health ◽  
Legal Status ◽  
Subsequent Treatment ◽  
Community Treatment ◽  
Service Utilisation ◽  
Community Treatment Orders ◽  
Mental Health Act ◽  
The Difference ◽  
Treatment Order ◽  
Community Treatment Order

Objective: Victoria, Australia, introduced reformed mental health legislation in 2014. The Act was based on a policy platform of recovery-oriented services, supported decision-making and minimisation of the use and duration of compulsory orders. This paper compares service utilisation and legal status after being on a community treatment order under the Mental Health Act 1986 (Vic) with that under the Mental Health Act 2014 (Vic). Methods: We obtained two distinct data sets of persons who had been on a community treatment order for at least 3 months and their subsequent treatment episodes over 2 years under the Mental Health Act and/or as an inpatient for the periods 2008–2010 (Mental Health Act 1986) and 2014–2016 (Mental Health Act 2014). The two sets were compared to assess the difference in use, duration and odds of having a further admission over 2 years. We also considered the mode of discharge – whether by the treating psychiatrist, external body or through expiry. Results: Compared with the Mental Health Act 1986, under the Mental Health Act 2014, index community treatment orders were shorter (mean 227 days compared with 335 days); there was a reduction in the mean number of community treatment orders in the 2 years following the index discharge − 1.1 compared with 1.5 (incidence rate ratio (IRR) = 0.71, 95% confidence interval = [0.63, 0.80]) – and a 51% reduction in days on an order over 2 years. There was a reduction in the number of subsequent orders for those whose order expired or was revoked by the psychiatrist under the Mental Health Act 2014 compared to those under the Mental Health Act 1986. The number of orders which were varied to an inpatient order by the authorised psychiatrist was notably greater under the Mental Health Act 2014. Conclusion: The reformed Mental Health Act has been successful in its intent to reduce the use and duration of compulsory orders in the community. The apparent increase in return to inpatient orders raises questions regarding the intensity and effectiveness of community treatment and context of service delivery.

scholarly journals A snap-shot of ‘long-term’ section 17 use in South-West England

2014 ◽  
Vol 1 (17) ◽  
pp. 75
Author(s):  
Bob Jones ◽  
Mat Kinton
Keyword(s):  
Mental Health ◽  
Community Treatment ◽  
The South ◽  
Community Based ◽  
Mental Health Act ◽  
South West ◽  
Statutory Duty ◽  
Leave Of Absence ◽  
South West England

<p>The Mental Health Act Commission (MHAC) does not have a culture of visiting patients in the community, having a primary statutory duty of visiting detained patients in hospital, and no remit over patients placed under Guardianship or Supervised Discharge (s.25A). The MHAC’s statutory remit does, however, encompass patients who remain liable to be detained but are granted leave of absence from hospital, and will extend to patients who are subject to supervised community treatment upon the implementation of SCT powers in October 2008.</p><p align="LEFT">In an attempt to get a better understanding of patient and process issues that are likely when visiting community-based patients, the MHAC has been running some exploratory visits to detained patients on long-term section 17 leave. These visits have been carried out under the MHAC’s statutory remit. This is a brief account of one such exercise in the South-West of England.</p>

scholarly journals Towards an Understanding of Supervised Community Treatment

2014 ◽  
Vol 1 (17) ◽  
pp. 7
Author(s):  
Mat Kinton
Keyword(s):  
Mental Health ◽  
The Other ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
England And Wales ◽  
Mental Health Act ◽  
Relationship Of ◽  
The Relationship

<p>I intend here to look at two related areas: first, the actual powers that supervised community treatment provides to clinicians, especially in relation to the administration of treatment, and, second, the relationship of SCT with the other community powers of the Mental Health Act, especially the power under s.17 to allow detained patients leave from hospital. Whether such a focus will enable us to be “sure of the thing” that is SCT is perhaps doubtful, and we obviously cannot resolve the question of how (or indeed if) the SCT regime will be operated in practice across England and Wales, but it may help us to think more clearly about the possibilities and prepare ourselves to untangle some of the knots established in the primary legislation. I will conclude with some comments on the potential numbers of patients involved and whether Scotland’s experience of community treatment orders tells us anything about the likely implementation of powers in England and Wales.</p>

scholarly journals Guardianship under the Mental Health Act 1983

2000 ◽  
Vol 24 (2) ◽  
pp. 51-52 ◽  
Author(s):  
Jenny Shaw ◽  
Barbara Hatfield ◽  
Sherrill Evans
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Social Services ◽  
Serious Mental Illness ◽  
Community Treatment ◽  
Clinical Implications ◽  
Community Treatment Orders ◽  
Mental Health Act ◽  
Illness Category ◽  
One Year

Aims and MethodTo describe the extent and variation in the use of Guardianship nationally. The Directors of Social Services were asked to provide details about Guardianship cases on two separate occasions one year apart.ResultsThere were 428 new Guardianship cases in 12 months. At the second enumeration, 73% of cases were within the mental illness category and 47% of these had serious mental illness.Clinical ImplicationsThere is much variation in the use of Guardianship. Further developments of this study will explore the reasons for this variation and will ascertain clinicians' views on Guardianship, supervised discharge and other community treatment orders.

scholarly journals Suicide rates among patients subject to community treatment orders in England during 2009–2018

BJPsych Open ◽  
2021 ◽  
Vol 7 (6) ◽  
Author(s):  
Isabelle M. Hunt ◽  
Roger T. Webb ◽  
Pauline Turnbull ◽  
Jane Graney ◽  
Saied Ibrahim ◽  
...  
Keyword(s):  
Mental Health ◽  
Suicide Risk ◽  
Psychiatric Patients ◽  
Case Series ◽  
Population Based ◽  
Time Dependent ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Suicide Rates ◽  
Discharged Patients

Background Community treatment orders (CTOs) enable patients to be treated in the community rather than under detention in hospital. Population-based studies of suicide among patients subject to a CTO are scarce. Aims To compare suicide rates among patients subject to a CTO with all discharged psychiatric patients and those detained for treatment but not subject to a CTO at discharge (‘CTO-eligible’ patients). Method From a national case series of patients who died by suicide within 12 months of contact with mental health services in England during 2009–2018, we estimated average annual suicide rates for all discharged patients, those on a CTO at the time of suicide, those ever treated under a CTO and CTO-eligible patients. Results Suicide rates for patients on a CTO at the time of suicide (191.3 per 100 000 patients) were lower than all discharged patients (482.3 per 100 000 discharges). Suicide rates were similar in those ever treated under a CTO (350.1 per 100 000 CTOs issued) and in CTO-eligible patients (382.9 per 100 000 discharges). Suicide rates within 12 months of discharge were higher in persons ever under a CTO (205.1 per 100 000 CTOs issued) than CTO-eligible patients (161.5 per 100 000 discharges), but this difference was reversed for rates after 12 months of discharge (153.2 per 100 000 CTOs issued v. 223.4 per 100 000 discharges). Conclusions CTOs may be effective in reducing suicide risk. The relative benefits of CTOs and intensive aftercare may be time-dependent, with the benefit of a CTO being less before 12 months after discharge but greater thereafter. CTO utilisation requires a careful balancing of patient safety versus autonomy.

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