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 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.

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 Facilities for carers of in-patients in forensic psychiatric services in England and Wales

2010 ◽  
Vol 34 (9) ◽  
pp. 381-384 ◽  
Author(s):  
Irene Cormac ◽  
Drew Lindon ◽  
Hannah Jones ◽  
Trevor Gedeon ◽  
Michael Ferriter
Keyword(s):  
Mental Health ◽  
Postal Survey ◽  
Psychiatric Services ◽  
Clinical Implications ◽  
England And Wales ◽  
Mental Health Settings ◽  
Forensic Psychiatric ◽  
Minority Ethnic ◽  
Psychiatric Facilities

Aims and methodA postal survey of forensic psychiatric facilities in England and Wales was undertaken to obtain information about the services provided for carers of in-patients within these services.ResultsForensic psychiatric services vary in the support and facilities provided for carers. Many do not comply with current legislation for carers. Most units informed carers of their rights to have an assessment, but only a minority provided facilities for carers from Black and minority ethnic backgrounds.Clinical implicationsForensic psychiatric services should meet standards for the involvement and support of carers in mental health settings, and comply with legislation for carers.

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

2018 ◽  
Vol 42 (5) ◽  
pp. 218-218
Author(s):  
Daniel M. Bennett ◽  
Andrew C. Bailey ◽  
Alasdair D. Forrest
Keyword(s):  
Community Treatment ◽  
National Data ◽  
Community Treatment Orders

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.

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