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.

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.

Emergencies, general medicine, ‘community treatment orders’, and ‘psychiatric advance statements’

2017 ◽  
Author(s):  
George Szmukler
Keyword(s):  
Decision Making ◽  
Psychiatric Treatment ◽  
Good Practice ◽  
General Medicine ◽  
Mental Illnesses ◽  
Community Treatment ◽  
Best Interests ◽  
Important Place ◽  
Decision Making Capacity ◽  
Advance Statements

The implications of the Fusion Law for general medicine, especially inpatient care when non-consensual and involuntary treatment is being considered, are examined in this chapter. The new burdens posed by regulation can be minimized by making requirements essentially parallel ‘good practice’. Involuntary psychiatric treatment in the community under the ‘decision-making capability–best interests (will and preferences)’ principles of the Fusion Law would be substantially different from the way it is commonly instituted today. The Fusion Law offers an important place for ‘advance statements’ and ‘advance directives’, supporting respect for a patient’s beliefs and values (or ‘will and preferences’). Illnesses that impair decision-making capacity, but that are relapsing-remitting—such as the majority of mental illnesses—are good candidates for such advance planning, yet such measures have rarely been employed to date.

scholarly journals Community Treatment Orders and Supported Decision-Making

2019 ◽  
Vol 10 ◽  
Author(s):  
Lisa Brophy ◽  
Renata Kokanovic ◽  
Jacinthe Flore ◽  
Bernadette McSherry ◽  
Helen Herrman
Keyword(s):  
Decision Making ◽  
Community Treatment ◽  
Community Treatment Orders

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

2017 ◽  
Vol 210 (5) ◽  
pp. 311-312 ◽  
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.

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

2011 ◽  
Vol 35 (9) ◽  
pp. 328-333 ◽  
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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