scholarly journals Service Users’ Knowledge and Views on Outpatients’ Compulsory Community Treatment Orders: A Cross-Sectional Matched Comparison Study

2019 ◽  
pp. 070674371982896 ◽  
Author(s):  
Arash Nakhost ◽  
Alexander I. F. Simpson ◽  
Frank Sirotich
Keyword(s):  
Community Treatment ◽  
Service Users ◽  
Comparison Study ◽  
Community Treatment Orders ◽  
Cross Sectional ◽  
Compulsory Community Treatment ◽  
Matched Comparison

scholarly journals Coercion in Outpatients under Community Treatment Orders: A Matched Comparison Study

2018 ◽  
Vol 63 (11) ◽  
pp. 757-765 ◽  
Author(s):  
Arash Nakhost ◽  
Frank Sirotich ◽  
Katherine M. Francombe Pridham ◽  
Vicky Stergiopoulos ◽  
Alexander I. F. Simpson
Keyword(s):  
Procedural Justice ◽  
Comparison Group ◽  
Psychiatric Treatment ◽  
Psychiatric Service ◽  
Community Mental Health Services ◽  
Community Treatment ◽  
Service Users ◽  
Community Treatment Orders ◽  
Treatment Access ◽  
Cross Sectional

Objective: Since the deinstitutionalization of psychiatric services around the world, the scope of outpatient psychiatric care has also increased to better support treatment access and adherence. For those with serious mental illness who may lack insight into their own illness, available interventions include coercive community practices such as mandated community treatment orders (CTOs). This paper examines the perceptions of coercion among service users treated with a CTO. Method: We used a cross-sectional comparative design where service users treated under a CTO were matched to a comparison group of voluntary psychiatric outpatients. Both groups were receiving intensive community mental health services ( n = 69 in each group). Participants were interviewed using a series of questionnaires aimed at evaluating their perceptions of coercion and other aspects of the psychiatric treatment. Results: The level of coercion reported by service users treated under a CTO was significantly higher than that in the comparison group. However, in adjusted analyses, service users’ perception of coercion, irrespective of their CTO status, was directly correlated with their previous experience with probation and inversely correlated with the sense of procedural justice in their treatment. Conclusions: Evaluation of psychiatric service users’ experiences of coercion should consider their past and current involvement with other types of coercive measures, particularly history of probation. Clinicians may be able to minimize these experiences of coercion by incorporating procedural justice principles into their practice.

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 Is compulsory community treatment ever justified?

2001 ◽  
Vol 25 (7) ◽  
pp. 268-270 ◽  
Author(s):  
Vanessa Pinfold ◽  
Jonathan Bindman
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Community Psychiatry ◽  
Chief Executive ◽  
Community Treatment ◽  
Service Users ◽  
Hospital Medical School ◽  
Consultant Psychiatrist ◽  
Compulsory Community Treatment

On the evening of 23 February 2000 at the Maudsley Hospital in London the motion ‘This house believes that compulsory community treatment is not justified’ was debated in front of an audience of mental health professionals, carers, service users and other members of the general public. Peter Campbell, a mental health system survivor, and Dr Frank Holloway, consultant psychiatrist at the South London and Maudsley Trust, supported the motion. Cliff Prior, Chief Executive of the National Schizophrenia Fellowship (NSF), and Professor Tom Burns, professor of community psychiatry at St George's Hospital Medical School, opposed it.

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 In hospital, at home, or not at all

2004 ◽  
Vol 28 (10) ◽  
pp. 360-363 ◽  
Author(s):  
Mike J. Crawford ◽  
Rebecca Gibbon ◽  
Elizabeth Ellis ◽  
Hannah Waters
Keyword(s):  
Patient Care ◽  
Patient Experiences ◽  
Community Treatment ◽  
Service Users ◽  
Compulsory Treatment ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Treatment Centre ◽  
To Receive ◽  
Improve Patient

Aims and MethodIn view of plans to reform Mental Health Act legislation to allow compulsory treatment in the community, we examined the views of service users about this form of care, and the most acceptable setting for its delivery. A cross-sectional survey of patients discharged from two in-patient units in West London over a 5-month period was carried out.ResultsHalf of the 109 respondents stated that compulsory treatment was justified under some circumstances; 103 people told us where they would prefer to receive compulsory treatment – 49 in their home, 41 in hospital and 13 in a community treatment centre. The most commonly stated reason for favouring home treatment was dislike of in-patient care.Clinical ImplicationsCompulsory treatment in the community may provide a means of improving patient experiences of non-consensual care. However, a significant minority of service users would rather this form of treatment was restricted to in-patient units. Continuing efforts are required to improve patient experiences of in-patient care.

scholarly journals Coercion: an understudied issue in mental health

2017 ◽  
Vol 34 (4) ◽  
pp. 221-222
Author(s):  
B. O’Donoghue
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Community Treatment ◽  
Future Research ◽  
Service Users ◽  
Involuntary Admission ◽  
Community Treatment Orders ◽  
Future Directions ◽  
Alternative Models

Coercion in mental health services is a controversial practice, yet it is a relatively understudied area. This special themed edition draws upon research from the international community with the aim of addressing issues related to coercion and involuntary admission. The issue covers topics such as community treatment orders, service users’ perspectives, alternative models of involving service users in their treatment, and future directions for coercion research. It is hoped that this edition will encourage funding and inspire future research on this important topic.

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