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.

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 in the UK 5 years on: a repeat national survey of psychiatrists

2016 ◽  
Vol 40 (3) ◽  
pp. 119-123 ◽  
Author(s):  
Ritz DeRidder ◽  
Andrew Molodynski ◽  
Catherine Manning ◽  
Pearse McCusker ◽  
Jorun Rugkåsa
Keyword(s):  
Clinical Practice ◽  
Patient Care ◽  
Treatment Adherence ◽  
National Survey ◽  
Community Treatment ◽  
Clinical Implications ◽  
Clinical Factors ◽  
Previous Survey ◽  
Community Treatment Orders ◽  
The Uk

Aims and methodCommunity treatment orders (CTOs) are increasingly embedded into UK practice and their use continues to rise. However, they remain highly controversial. We surveyed psychiatrists to establish their experiences and current opinions of using CTOs and to compare findings with our previous survey conducted in 2010.ResultsThe opinions of psychiatrists in the UK have not changed since 2010 in spite of recent evidence questioning the effectiveness of CTOs. Clinical factors (the need for engagement and treatment adherence, and the achievement of adherence and improved insight) remain the most important considerations in initiating and discharging a CTO.Clinical implicationsGiven the accumulating evidence from research and clinical practice that CTOs do not improve outcomes, it is concerning that psychiatrists' opinions have not altered in response, particularly given the implications for patient care.

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 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.

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.

Community treatment order legislation in the Commonwealth

2016 ◽  
Author(s):  
John Dawson
Keyword(s):  
Outpatient Treatment ◽  
Community Care ◽  
Common Law ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Treatment Plans ◽  
The Uk ◽  
Treatment Order ◽  
Community Treatment Order

This chapter provides an overview of legislation governing the use of community treatment orders (CTOs)—that authorize compulsory outpatient treatment—in the UK, Canada, Australia, and New Zealand. It focuses particularly on the cluster of powers that CTOs confer on community mental health teams, permitting them to continue supervising a person’s outpatient care. It covers the criteria, procedures, and structure of authority for a CTO, the conditions such an order can impose on a person’s community care, the role of statutory treatment plans, and the powers available to enforce the outpatient treatment regime, especially the power of recall to hospital—analysing and comparing the subtly different regimes enacted in these Commonwealth nations that share a common law tradition.

scholarly journals Community treatment orders in England: review of usage from national data

2018 ◽  
Vol 42 (3) ◽  
pp. 119-122 ◽  
Author(s):  
Susham Gupta ◽  
Elvan U. Akyuz ◽  
Toby Baldwin ◽  
David Curtis
Keyword(s):  
Mental Health ◽  
Service Provision ◽  
Psychiatric Service ◽  
Community Treatment ◽  
Clinical Implications ◽  
Economic Downturn ◽  
National Data ◽  
Community Treatment Orders ◽  
England And Wales ◽  
Low Rate

Aims and methodCommunity treatment orders (CTOs) have been in used in England and Wales since November 2008; however, their effectiveness has been debated widely, as has the question of which methodology is appropriate to investigate them. This paper uses national data to explore the use of CTOs in England.ResultsAbout 5500 patients are subject to CTOs at any one time. Each year, ~4500 patients are made subject to a CTO each year and ~2500 are fully discharged, usually by the responsible clinician; fewer than half of CTO patients are recalled, and two-thirds of recalls end in revocation. The low rate of CTO discharges by mental health tribunals (below 5%) suggests that they are not used inappropriately.Clinical implicationsThe introduction of CTOs in England has coincided with a reduction in psychiatric service provision due to the economic downturn. Pressures on services might be even more severe if patients currently subject to CTOs instead needed to be detained as in-patients.Declaration of interestNone.

scholarly journals Community treatment orders: background and implications of the OCTET trial

2014 ◽  
Vol 38 (1) ◽  
pp. 3-5 ◽  
Author(s):  
Tom Burns ◽  
Andrew Molodynski
Keyword(s):  
Controlled Trial ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
International Evidence ◽  
Obvious Benefit ◽  
Evaluation Trial ◽  
Randomised Controlled ◽  
The Uk ◽  
Treatment Order ◽  
Community Treatment Order

SummaryCommunity treatment orders (CTOs) were introduced into the UK despite unconvincing international evidence for their effectiveness. The Oxford Community Treatment Order Evaluation Trial (OCTET) is a multisite randomised controlled trial of 333 patients with psychosis conducted in the UK. It confirms an absence of any obvious benefit in reducing relapse despite significant curtailment of liberty. Community mental health teams need to seriously consider whether they should continue using CTOs or shift their clinical focus to strengthening the working alliance.

Men who have sex with men who are born abroad and diagnosed with HIV in England and Wales: an epidemiological perspective

2005 ◽  
Vol 16 (9) ◽  
pp. 618-621 ◽  
Author(s):  
S Dougan ◽  
J Elford ◽  
K Sinka ◽  
K A Fenton ◽  
B G Evans
Keyword(s):  
Sexual Health ◽  
Significant Proportion ◽  
Health Needs ◽  
Country Of Birth ◽  
England And Wales ◽  
Black African ◽  
South Central ◽  
Black Caribbean ◽  
Sex With Men ◽  
The Uk

Relatively little is known about the sexual health needs of men who have sex with men (MSM) born abroad who reside in the UK. We describe here the epidemiology of HIV among MSM born outside the UK and diagnosed with HIV in England and Wales. Reports of HIV diagnoses in England and Wales received at the Health Protection Agency Centre for Infections were analysed. Between 2000 and 2003, 6386 MSM were diagnosed with HIV in England and Wales. Country of birth was recorded for 3571 (56%). Of those with country of birth reported, 2598 (73%) were born in the UK and 973 (27%) abroad. Of those born abroad (973), 424 (44%) were born in Europe, 141 (15%) in Africa, 104 (11%) in South/Central America and the remainder in other regions. Where reported (949), 69% of MSM born abroad were White, 12% other/mixed, 9% Black Caribbean and 7% Black African. Probable country of infection was reported for 612 MSM born abroad: 52% were infected in the UK, 43% in their region of birth and 5% in another region. Men born abroad represent a significant proportion of HIV diagnoses among MSM in England and Wales. More than half probably acquired their HIV infection in the UK, strengthening the call for targeted HIV prevention and sexual health promotion among MSM who are not born in England and Wales.

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