scholarly journals An empirical ethical analysis of community treatment orders within mental health services in England

2016 ◽  
Vol 11 (4) ◽  
pp. 130-139 ◽  
Author(s):  
Michael Dunn ◽  
Krysia Canvin ◽  
Jorun Rugkåsa ◽  
Julia Sinclair ◽  
Tom Burns
Keyword(s):  
Mental Health ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Ethical Reason ◽  
Complex Needs ◽  
Outpatient Mental Health ◽  
Care And Support ◽  
Health Practitioners ◽  
Mental Health Settings ◽  
Legal Mechanism

Community treatment orders are a legal mechanism to extend powers of compulsion into outpatient mental health settings in certain circumstances. Previous ethical analyses of these powers have explored a perceived tension between a duty to respect personal freedoms and autonomy and a duty to ensure that patients with the most complex needs are able to receive beneficial care and support that maximises their welfare in the longer-term. This empirical ethics paper presents an analysis of 75 interviews with psychiatrists, patients and family carers to show how these ethical considerations map onto the different ways that community treatment orders are used and experienced in practice. A complex and nuanced account of how the requirements to respect patients’ autonomy, to respect patients’ liberty and to act beneficently should be interpreted in order to make judgements about the ethics of community treatment orders is presented. The article argues that, due to such complexity, no general ethical justification for community treatment orders can be provided, but a justification on the basis of the promotion of patients’ autonomy could provide an ethical reason for community mental health practitioners to make use of a community treatment order in some limited circumstances.

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.

scholarly journals Community treatment orders and mental health social work: Issues for policy and practice in the UK and Ireland

2019 ◽  
Vol 64 ◽  
pp. 230-237 ◽  
Author(s):  
Jim Campbell ◽  
Gavin Davidson ◽  
Pearse McCusker ◽  
Hannah Jobling ◽  
Tom Slater
Keyword(s):  
Mental Health ◽  
Social Work ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Policy And Practice ◽  
The Uk

scholarly journals Three Decades and Counting: HIV Service Provision in Outpatient Mental Health Settings

2020 ◽  
Vol 71 (7) ◽  
pp. 726-729
Author(s):  
Karen McKinnon ◽  
James Satriano ◽  
Jean-Marie Alves-Bradford ◽  
Whitney Erby ◽  
Fatima J. Jaafar ◽  
...  
Keyword(s):  
Mental Health ◽  
Service Provision ◽  
Outpatient Mental Health ◽  
Mental Health Settings

The ethics of coercion in community mental health care

2016 ◽  
Author(s):  
Tania Gergel ◽  
George Szmukler
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Community Mental Health ◽  
Mental Health Care ◽  
Community Treatment ◽  
Best Interests ◽  
Community Mental Health Care ◽  
Involuntary Treatment ◽  
Community Treatment Orders ◽  
Specific Context

The specific context of community mental health care affects the debate surrounding coercion in psychiatry, not by raising radically new questions but by highlighting the complexity of this debate and some of the associated ethical difficulties. This chapter begins by looking at the varying conventional justifications for involuntary treatment and then considers the different mechanisms through which such ‘coercion’ is enforced within the community—from formal compulsion via community treatment orders (CTOs) through to ‘softer’ pressures, such as ‘persuasion’ or ‘interpersonal leverage’. Some commonly accepted ideas surrounding interventions such as ‘incentives’ and ‘threats’ are challenged. The chapter concludes with some broad suggestions as to a how a reformulated ‘decision-making capability and best interests’ approach may be one way to increase the ethical viability of community coercion.

Coercion in Community Mental Health Care

2016 ◽  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mentally Ill ◽  
Community Care ◽  
Current Knowledge ◽  
Community Services ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Improved Outcome

The use of coercion is one of the defining issues of mental health care and has been intensely controversial since the very earliest attempts to contain and treat the mentally ill. The balance between respecting autonomy and ensuring that those who most need treatment and support are provided with it has never been finer, with the ‘move into the community’ in many high-income countries over the last 50 years and the development of community services. The vast majority of patients worldwide now receive mental health care outside hospital, and this trend is increasing. New models of community care, such as assertive community treatment (ACT), have evolved as a result and there are widespread provisions for compulsory treatment in the community in the form of community treatment orders. These legal mechanisms now exist in over 75 jurisdictions worldwide. Many people using community services feel coerced, but at the same time intensive forms of treatment such as ACT, which arguably add pressure to patients to engage in treatment, have been associated with improved outcome. This volume draws together current knowledge about coercive practices worldwide, both those founded in law and those ‘informal’ processes whose coerciveness remains contested. It does so from a variety of perspectives, drawing on diverse disciplines such as history, law, sociology, anthropology, and medicine and for is explored

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