scholarly journals Community treatment orders – a bridge too far?

1999 ◽  
Vol 23 (11) ◽  
pp. 644-646 ◽  
Author(s):  
Joanna Moncrieff ◽  
Marceleno Smyth
Keyword(s):  
Mentally Ill ◽  
Community Care ◽  
Community Treatment ◽  
Department Of Health ◽  
Mental Health Legislation ◽  
The Media ◽  
The Government ◽  
Health Legislation ◽  
Treatment Order ◽  
Community Treatment Order

Compulsory treatment in the community is high on the agenda in the current review of mental health legislation and the government has already announced its intention to introduce a ‘community treatment order’ (CTO; Department of Health, 1998). Concern about the implications of community care has been gathering momentum over the last decade, spurred on by tragedies such as those involving Ben Silcock and Christopher Clunis in the early 1990s. The notion that community care has failed has taken deep root with the media and the government (Department of Health, 1998). This is despite the lack of any evidence to suggest that mental illness is less effectively treated (Johnstone et al, 1991; Anderson et al, 1993) or that violence attributable to the mentally ill is rising (Taylor & Gunn, 1999). It also indicates a tendency to ignore the fact that patients prefer to live in the community (Tyrer, 1998). Psychiatrists, who are increasingly implicated in this purported failure of care, feel besieged. In such a climate, the promise of more power is understandably attractive. However, we feel that psychiatrists should resist pressure for this sort of ‘quick fix’ and reflect upon some of the dilemmas involved.

scholarly journals Race equality, human rights and mental health legislation: Recent developments in England and Wales

2007 ◽  
Vol 13 (3) ◽  
pp. 3
Author(s):  
Lord Patel Of Bradford ◽  
Chris Heginbotham
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Mental Disorder ◽  
Community Treatment ◽  
Mental Health Legislation ◽  
Recent Developments ◽  
Definition Of ◽  
Health Legislation ◽  
Treatment Order ◽  
Community Treatment Order

<p>England now has revised mental health legislation following the passage of a mental health Bill through both Houses of Parliament following protracted discussions over seven years. The Mental Health Bill 2006, amending the Mental Health Act 1983, eventually received Royal Assent on 19 July 2007. There is much that could be said about the new Act, which makes a number of important changes to the present legislation. These changes include a new single definition of mental disorder; the abolition of the so-called ‘treatability test’; and the extension of compulsion into the community through a supervised community treatment order.</p>

scholarly journals Involuntary community treatment in New South Wales, Australia

1995 ◽  
Vol 19 (1) ◽  
pp. 45-47 ◽  
Author(s):  
John Hambridge ◽  
Nicola Watt
Keyword(s):  
Mental Health ◽  
Mentally Ill ◽  
New South ◽  
New South Wales ◽  
Community Treatment ◽  
Compulsory Treatment ◽  
Perceived Benefits ◽  
South Wales ◽  
Mental Health Legislation ◽  
Health Legislation

The New South Wales Mental Health Act (1990) heralded a number of important changes to mental health legislation in the state. One of these was the option to give compulsory treatment to mentally ill clients living in the community. This article briefly explains community treatment under the Act, and the perceived benefits and the limitations of such legislation. A case example is used to illustrate some of these points. Involuntary community treatment is seen as a less restrictive alternative to hospitalisation for a number of mentally ill clients, but the use of such provisions demands significant resources from the supervising agency.

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.

Uses of Community Treatment Orders in New Zealand: Early Findings

2001 ◽  
Vol 35 (2) ◽  
pp. 190-195 ◽  
Author(s):  
John Dawson ◽  
Sarah Romans
Keyword(s):  
New Zealand ◽  
Community Care ◽  
Significant Proportion ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Mental Health Legislation ◽  
High Level ◽  
Health Legislation ◽  
Level Of Agreement

Objective: To assess the uses of Community Treatment Orders (CommTOs) in New Zealand. Method: A retrospective study of patients' records held by the regional administrator of mental health legislation and a survey of psychiatrists attending a conference in Dunedin. Results: Males under Community Treatment Orders (CommTOs) outnumbered females 6:4; a high proportion were considered to have a major psychotic disorder; and one fifth remained under a CommTO for more than a year without inpatient care. Among the psychiatrists, there was a high level of agreement that, when used appropriately, the benefits of CommTOs outweigh their coercive impact on the patients; the most strongly supported indicator for use was the promotion of compliance with medication. The rate of use of CommTOs in Otago is remarkably similar to the rate in Victoria, Australia. Conclusions: Records suggest that a significant proportion of patients under CommTOs are not soon readmitted; and many clinicians in New Zealand consider CommTOs to be a useful strategy for managing the community care of long-term patients with schizophrenia and major affective disorders.

scholarly journals Proportionality of legal discrimination

2010 ◽  
Vol 7 (1) ◽  
pp. 24-24
Author(s):  
Partha Gangopadhyay
Keyword(s):  
Mental Health ◽  
Code Of Practice ◽  
Department Of Health ◽  
Mental Health Legislation ◽  
Mental Capacity Act 2005 ◽  
Legal Duty ◽  
The Government ◽  
Mental Capacity Act ◽  
The Uk ◽  
Health Legislation

Sir: The article by Zigmond (2009) made for interesting reading. Mental health law is about balancing the need to detain people in order to protect them or other people from harm and the need to respect people's human rights and autonomy. In the UK, there was much concern during the development of recent mental health legislation, in particular the Mental Capacity Act 2005, that the government had got this balance wrong. Many of these concerns have been addressed in the updated Code of Practice to the 1983 Mental Health Act, which is an essential guide to practising under the Act (Department of Health, 2008). There is no legal duty to comply with the Code, but professionals must have regard to it and record the reason for any departure from the guidance (which can be subject to legal challenge).

scholarly journals Guardianship – a case for wider use

1993 ◽  
Vol 17 (5) ◽  
pp. 276-278 ◽  
Author(s):  
R. L. Symonds
Keyword(s):  
Mental Health ◽  
Royal College ◽  
Community Care ◽  
Community Treatment ◽  
Care Programme ◽  
Mental Health Act ◽  
The Future ◽  
Treatment Order ◽  
Community Treatment Order

Few psychiatrists have had much experience of guardianship (Section 7, Mental Health Act, 1983). The two cases described have been successful and suggest wider use of this section. It seems apposite in view of the Royal College of Psychiatrists' advice on discharge of patients from hospital, and discussion on a community treatment order; the continuing drive to community care, as codified in the ‘Care Programme Approach’; and the need in the future to treat increasingly disturbed individuals in the community as envisaged in the Reed report.

Reform or revolution? Mental health legislation and the development of community care

2020 ◽  
pp. 73-94
Author(s):  
Ian Cummins
Keyword(s):  
Mental Health ◽  
Risk Management ◽  
Civil Rights ◽  
Community Care ◽  
The Other ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Mental Health Legislation ◽  
Progressive Reforms ◽  
Health Legislation

This chapter will explore the development of mental health legislation from the introduction of the 1983 MHA to the introduction of Community Treatment Orders (CTOs) in the reforms of 2007. The chapter ends with a brief discussion of the Wessely review of the MHA that was completed in 2018. Reform of mental health legislation reflects two potentially conflicting strands. One is the state’s power to incarcerate the “mad”, the other is the move to protect the civil rights of those who are subject to such legislation. The development of legislation reflects the broader pattern of community care as a policy. The initial optimism and progressive reforms of the early 1980s are overtaken by a more managerialist, pragmatic approach which focuses on risk and risk management

Community treatment orders increase community care and delay readmission while in force: Results from a large population-based study

2018 ◽  
Vol 53 (3) ◽  
pp. 228-235 ◽  
Author(s):  
Anthony Harris ◽  
Wendy Chen ◽  
Sharon Jones ◽  
Melissa Hulme ◽  
Philip Burgess ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Rate Ratio ◽  
Community Care ◽  
Incidence Rate Ratio ◽  
Large Population ◽  
Population Based ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Treatment Order ◽  
Community Treatment Order

Objective: There is debate about the effectiveness of community treatment orders in the management of people with a severe mental illness. While some case–control studies suggest community treatment orders reduce hospital readmissions, three randomised controlled trials find no effects. These randomised controlled trials measure outcomes over a longer period than the community treatment order duration and assess the combined effectiveness of community treatment orders both during and after the intervention. This study examines the effectiveness of community treatment orders in a large population-based sample, restricting observation to the period under a community treatment order. Methods: All persons ( n = 5548) receiving a community treatment order in New South Wales, Australia, over the period 2004–2009 were identified. Controls were matched using a propensity score based on demographic, clinical and prior care variables. A baseline period equal to each case’s duration of treatment was constructed. Treatment effects were compared using zero-inflated negative binomial regression, adjusting for demographics, clinical characteristics and pre-community treatment order care. Results: Compared to matched controls, people on community treatment orders were less likely to be readmitted (odds ratio = 0.90, 95% confidence interval = [0.84, 0.97]) and had a significantly longer time to their first readmission (incidence rate ratio = 1.47, 95% confidence interval = [1.36, 1.58]), fewer hospital admissions (incidence rate ratio = 0.90, 95% confidence interval = [0.84, 0.96]) and more days of community care (incidence rate ratio = 1.55, 95% confidence interval = [1.51, 1.59]). Increased community care and delayed first admission were found for all durations of community treatment order care. Reduced odds of readmission were limited to people with 6 months or less of community treatment order care, and reduced number of admissions and days in hospital to people with prolonged (>24 months) community treatment order care. Conclusion: In this large population-based study, community treatment orders increase community care and delay rehospitalisation while they are in operation. Some negative findings in this field may reflect the use of observation periods longer than the period of active intervention.

scholarly journals Caring for People: a critical review of British Government policy for the community care of the mentally ill

1990 ◽  
Vol 14 (11) ◽  
pp. 641-645 ◽  
Author(s):  
Frank Holloway
Keyword(s):  
Government Policy ◽  
Mentally Ill ◽  
Community Care ◽  
The Elderly ◽  
White Paper ◽  
Care For The Elderly ◽  
Department Of Health ◽  
Specific Responsibility ◽  
The Government ◽  
The One

The development of ‘community care’ for the elderly, mentally ill, mentally handicapped and physically disabled has been Government policy in Britain since the 1950s. Problems with implementation of this policy led the Audit Commission (1986) to conclude that “the one option that is not tenable is to do nothing about present financial, organisational and staffing arrangements”. Sir Roy Griffiths was commissioned to review “the way funds are used to support community care policy …”. Radical solutions were proposed and subsequently incorporated in the Government White Paper Caring for People (Department of Health, 1989a). However, two very significant measures were not accepted: the ‘ring-fencing’ of community care monies and the creation of a ministerial post within the Department of Health with specific responsibility for community care.

The Statutory Definition of a Mentally ILL Person in N.S.W. 1958–1983

1984 ◽  
Vol 18 (3) ◽  
pp. 218-223 ◽  
Author(s):  
Peter B. Shea
Keyword(s):  
Mental Health ◽  
Mentally Ill ◽  
Department Of Health ◽  
Mental Health Legislation ◽  
Potential Problems ◽  
Points Of View ◽  
Definition Of ◽  
Health Legislation

For 11 years the N.S.W. mental health legislation was under review. The new legislation was finally enacted in 1983. Several different committees worked on the development of the legislation over the 11-year period. Two government departments, the Department of Health and the Attorney-General's Department, were involved in the preparation of the legislation. As a result, many parts of the Act represent an uneasy compromise between the medical-humanitarian and legal points of view. The process of development of the definition of a mentally ill person, which is traced in this article, exemplifies this. Features of the new definition are critically reviewed and potential problems discussed.

Sign in / Sign up

Export Citation Format

Share Document