scholarly journals Impact of introducing capacity-based mental health legislation on the use of community treatment orders in Norway: case registry study

BJPsych Open ◽  
2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Georg Høyer ◽  
Olav Nyttingnes ◽  
Jorun Rugkåsa ◽  
Ekaterina Sharashova ◽  
Tone Breines Simonsen ◽  
...  
Keyword(s):  
Mental Health ◽  
Incidence Rates ◽  
Community Treatment ◽  
Prevalence Rates ◽  
Community Treatment Orders ◽  
Retrospective Case ◽  
Case Register ◽  
Mental Health Act ◽  
Catchment Areas ◽  
Involuntary Care

Background In 2017, a capacity-based criterion was added to the Norwegian Mental Health Act, stating that those with capacity to consent to treatment cannot be subjected to involuntary care unless there is risk to themselves or others. This was expected to reduce incidence and prevalence rates, and the duration of episodes of involuntary care, in particular regarding community treatment orders (CTOs). Aims The aim was to investigate whether the capacity-based criterion had the expected impact on the use of CTOs. Method This retrospective case register study included two catchment areas serving 16% of the Norwegian population (aged ≥18). In total, 760 patients subject to 921 CTOs between 1 January 2015 and 31 December 2019 were included to compare the use of CTOs 2 years before and 2 years after the legal reform. Results CTO incidence rates and duration did not change after the reform, whereas prevalence rates were significantly reduced. This was explained by a sharp increase in termination of CTOs in the year of the reform, after which it reduced and settled on a slightly higher leven than before the reform. We found an unexpected significant increase in the use of involuntary treatment orders for patients on CTOs after the reform. Conclusions The expected impact on CTO use of introducing a capacity-based criterion in the Norwegian Mental Health Act was not confirmed by our study. Given the existing challenges related to defining and assessing decision-making capacity, studies examining the validity of capacity assessments and their impact on the use of coercion in clinical practice are urgently needed.

scholarly journals This strange republic of the good: Community treatment orders and their conditions

2014 ◽  
pp. 39 ◽  
Author(s):  
David Hewitt
Keyword(s):  
Mental Health ◽  
Health Professional ◽  
Mental Health Professional ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Mental Health Act ◽  
Treatment Order ◽  
Community Treatment Order

The Community Treatment Order (CTO) was introduced by the Mental Health Act  2007, and from the start, it was controversial. There is evidence that even the principle of community compulsion was opposed by a majority of psychiatrists, and it was said that many would resign rather than implement CTOs. Happily, that prediction has not been realised. In fact, it seems that many psychiatrists, and more than one Approved Mental Health Professional (AMHP), have seized upon CTOs with something approaching alacrity.

scholarly journals MENTAL HEALTH ACT, MALTA 2012 - A personal reflection on 5 years working with a new legal framework

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J M Cachia
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Planning Process ◽  
Community Support ◽  
Critical Issue ◽  
Community Treatment ◽  
Care Process ◽  
Care Plans ◽  
Mental Health Act ◽  
Involuntary Care

Abstract The Commissioner for the Promotion of Rights of Persons with Mental Disorders (CMH) was established in Article 5 of the Mental Health Act approved by the Maltese Parliament in December 2012. The whole Act was completely in force on 10th October 2014. The involuntary care process is being closely monitored. Patients are being followed up within the time-frames established by the new law. Although not strictly comparable, length of stay in involuntary care has diminished radically. Patients are being discharged from compulsory treatment orders or transferred to community treatment orders rather than being left on “leave of absence”. Community involuntary care is the preferred option of following up difficult cases. This shift requires commitment to strengthen community support services and render them sustainable. The applications for involuntary care are progressively being better completed and the quality of the information backing requests for involuntary detention of persons is improving. Care plans are being submitted, but their completeness and their quality merits revision. The issue of availability of human resources is a critical issue which regularly features in feedback with care teams. Evidence of greater involvement of patients and responsible carers in the care planning process should be better documented if it is indeed happening. The level of awareness of patients’ rights in terms of the Act merits deeper evaluation. The CMH must continue to provide a voice to vulnerable persons with mental disorders and their loved ones. Maximization of the potential of persons with mental disorders is not only a question of social justice but also critical for the sustainability of our health system and the prosperity of our society. The burden of mental disorders is increasing exponentially with the modernization of our society and those who are not coping with this burden merit active consideration and support. Key messages Public health advocacy and the improvement of patient rights. The use of legislative tools in reforming service delivery.

scholarly journals Community treatment orders and associations with readmission rates and duration of psychiatric hospital admission: a controlled electronic case register study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e035121 ◽  
Author(s):  
Wikus Barkhuizen ◽  
Alexis E Cullen ◽  
Hitesh Shetty ◽  
Megan Pritchard ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Mental Health ◽  
Mortality Rate ◽  
Psychiatric Hospital ◽  
Mental Healthcare ◽  
Index Admission ◽  
Community Treatment ◽  
Lower Mortality ◽  
Community Treatment Orders ◽  
Electronic Health Record Data ◽  
Mental Health Act

ObjectivesLimited evidence is available regarding the effect of community treatment orders (CTOs) on mortality and readmission to psychiatric hospital. We compared clinical outcomes between patients placed on CTOs to a control group of patients discharged to voluntary community mental healthcare.Design and settingAn observational study using deidentified electronic health record data from inpatients receiving mental healthcare in South London using the Clinical Record Interactive Search (CRIS) system. Data from patients discharged between November 2008 and May 2014 from compulsory inpatient treatment under the Mental Health Act were analysed.Participants830 participants discharged on a CTO (mean age 40 years; 63% male) and 3659 control participants discharged without a CTO (mean age 42 years; 53% male).Outcome measuresThe number of days spent in the community until readmission, the number of days spent in inpatient care in the 2 years prior to and the 2 years following the index admission and mortality.ResultsThe mean duration of a CTO was 3.2 years. Patients receiving care from forensic psychiatry services were five times more likely and patients receiving a long-acting injectable antipsychotic were twice as likely to be placed on a CTO. There was a significant association between CTO receipt and readmission in adjusted models (HR: 1.60, 95% CI 1.42 to 1.80, p<0.001). Compared with controls, patients on a CTO spent 17.3 additional days (95% CI 4.0 to 30.6, p=0.011) in a psychiatric hospital in the 2 years following index admission and had a lower mortality rate (HR: 0.66, 95% CI 0.50 to 0.88, p=0.004).ConclusionsMany patients spent longer on CTOs than initially anticipated by policymakers. Those on CTOs are readmitted sooner, spend more time in hospital and have a lower mortality rate. These findings merit consideration in future amendments to the UK Mental Health Act.

scholarly journals Personality disorder and the Mental Health Act 1983 (amended)

2010 ◽  
Vol 16 (5) ◽  
pp. 329-335
Author(s):  
Piyal Sen ◽  
Ashley Irons
Keyword(s):  
Mental Health ◽  
Personality Disorder ◽  
Community Treatment ◽  
The Political ◽  
Specific Reference ◽  
Political Climate ◽  
Community Treatment Orders ◽  
Usual Practice ◽  
Mental Health Act ◽  
Definition Of

SummaryThe Mental Health Act 1983 now incorporates amendments introduced in 2007. This article explores features of the amended Act that affect the treatment of patients with personality disorder in England and Wales. It discusses issues such as the broad definition of mental disorder, treatability and professional roles, with specific reference to how they might, or might not, affect usual practice concerning patients with personality disorder. It also comments on elements within the Act that could positively affect people with personality disorder, such as community treatment orders, provision to change their ‘nearest relative’ and statutory advocacy services. The political climate in which the Act has been amended is commented on, as well as how this might potentially compromise some of the positives within the Act.

Clinical stability in the community associated with long-term approved leave under the Mental Health Act 2001

2014 ◽  
Vol 31 (2) ◽  
pp. 143-148 ◽  
Author(s):  
E. Bainbridge ◽  
F. Byrne ◽  
B. Hallahan ◽  
C. McDonald
Keyword(s):  
Mental Health ◽  
Case Report ◽  
Community Treatment ◽  
Residential Setting ◽  
Community Treatment Orders ◽  
Psychotic Illness ◽  
Persistent Symptoms ◽  
Mental Health Act ◽  
Clinical Stability

IntroductionWe present the case of a 27-year-old man with a background diagnosis of treatment resistant schizophrenia and absent insight who for the last 3 years has been residing in a high support residential setting on approved leave under the Mental Health Act (MHA) 2001. The case demonstrates how this man achieved clinical stability in the community with the assistance of long-term involuntary admission under the MHA 2001, in contrast to the previous years of his illness in which he had suffered multiple relapses of his psychotic illness with ssociated distress, poor self-care and repeated in-patient re-admissions. We discuss the equivalent use of community treatment orders in other jurisdictions and how the judicious use of approved leave under the MHA 2001 may be used as an alternative in Ireland where community treatment orders are not currently available.MethodCase Report.ConclusionThe case report highlights how the use of long-term approved leave under the MHA2001 may be used as alternative in Ireland to mimic CTOs for certain difficult to treat patients with psychotic illness who would benefit from ongoing treatment, but lack capacity to engage in such treatment due to persistent symptoms and lack of insight.

scholarly journals Does legislative change affect the use and duration of compulsory treatment orders?

2018 ◽  
Vol 53 (5) ◽  
pp. 433-440 ◽  
Author(s):  
Ruth Vine ◽  
Holly Tibble ◽  
Jane Pirkis ◽  
Fiona Judd ◽  
Matthew J Spittal
Keyword(s):  
Mental Health ◽  
Legal Status ◽  
Subsequent Treatment ◽  
Community Treatment ◽  
Service Utilisation ◽  
Community Treatment Orders ◽  
Mental Health Act ◽  
The Difference ◽  
Treatment Order ◽  
Community Treatment Order

Objective: Victoria, Australia, introduced reformed mental health legislation in 2014. The Act was based on a policy platform of recovery-oriented services, supported decision-making and minimisation of the use and duration of compulsory orders. This paper compares service utilisation and legal status after being on a community treatment order under the Mental Health Act 1986 (Vic) with that under the Mental Health Act 2014 (Vic). Methods: We obtained two distinct data sets of persons who had been on a community treatment order for at least 3 months and their subsequent treatment episodes over 2 years under the Mental Health Act and/or as an inpatient for the periods 2008–2010 (Mental Health Act 1986) and 2014–2016 (Mental Health Act 2014). The two sets were compared to assess the difference in use, duration and odds of having a further admission over 2 years. We also considered the mode of discharge – whether by the treating psychiatrist, external body or through expiry. Results: Compared with the Mental Health Act 1986, under the Mental Health Act 2014, index community treatment orders were shorter (mean 227 days compared with 335 days); there was a reduction in the mean number of community treatment orders in the 2 years following the index discharge − 1.1 compared with 1.5 (incidence rate ratio (IRR) = 0.71, 95% confidence interval = [0.63, 0.80]) – and a 51% reduction in days on an order over 2 years. There was a reduction in the number of subsequent orders for those whose order expired or was revoked by the psychiatrist under the Mental Health Act 2014 compared to those under the Mental Health Act 1986. The number of orders which were varied to an inpatient order by the authorised psychiatrist was notably greater under the Mental Health Act 2014. Conclusion: The reformed Mental Health Act has been successful in its intent to reduce the use and duration of compulsory orders in the community. The apparent increase in return to inpatient orders raises questions regarding the intensity and effectiveness of community treatment and context of service delivery.

scholarly journals Out-patient commitment order use in Norway: incidence and prevalence rates, duration and use of mental health services from the Norwegian Outpatient Commitment Study

BJPsych Open ◽  
2019 ◽  
Vol 5 (5) ◽  
Author(s):  
Henriette Riley ◽  
Ekaterina Sharashova ◽  
Jorun Rugkåsa ◽  
Olav Nyttingnes ◽  
Tore Buer Christensen ◽  
...  
Keyword(s):  
Patient Care ◽  
Prevalence Rates ◽  
Retrospective Case ◽  
Outpatient Commitment ◽  
Case Register ◽  
Commitment Period ◽  
Norwegian Population ◽  
Catchment Areas ◽  
Service Areas ◽  
Before And After

Background Norway authorised out-patient commitment in 1961, but there is a lack of representative and complete data on the use of out-patient commitment orders. Aims To establish the incidence and prevalence rates on the use of out-patient commitment in Norway, and how these vary across service areas. Further, to study variations in out-patient commitment across service areas, and use of in-patient services before and after implementation of out-patient commitment orders. Finally, to identify determinants for the duration of out-patient commitment orders and time to readmission. Method Retrospective case register study based on medical files of all patients with an out-patient commitment order in 2008–2012 in six catchment areas in Norway, covering one-third of the Norwegian population aged 18 years or more. For a subsample of patients, we recorded use of in-patient care 3 years before and after their first-ever out-patient commitment. Results Annual incidence varied between 20.7 and 28.4, and prevalence between 36.5 and 48.9, per 100 000 population aged 18 years or above. Rates differed significantly between catchment areas. Mean out-patient commitment duration was 727 days (s.d. = 889). Use of in-patient care decreased significantly in the 3 years after out-patient commitment compared with the 3 years before. Use of antipsychotic medication through the whole out-patient commitment period and fewer in-patient episodes in the 3 years before out-patient commitment predicted longer time to readmission. Conclusions Mechanisms behind the pronounced variations in use of out-patient commitment between sites call for further studies. Use of in-patient care was significantly reduced in the 3 years after a first-ever out-patient commitment order was made. Declaration of interest None.

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.

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