What counts as ‘counter-conduct’? A governmental analysis of resistance in the face of compulsory community care

2016 ◽  
Author(s):  
Hannah Jobling
Keyword(s):  
Community Care ◽  
Ethnographic Study ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Binary Forms ◽  
Target Groups ◽  
Self In Relation ◽  
Policy Interventions ◽  
Disciplinary Policy ◽  
The Face

In this chapter the findings of an ethnographic study of Community treatment orders (CTOs) in action are reported on, focusing on how individuals made subject to CTOs perceive the role the CTO has in their lives, and their subsequent responses to its imposition. Individuals’ conceptions of self in relation to disciplinary policy interventions can lead to complex, ambiguous and perhaps unexpected responses to compulsion, which are not easily categorised into binary forms of compliance and resistance. The analysis of CTOs underlines the value of a governmentality perspective that eschews simple linear understandings of how ‘target’ groups will respond to policy interventions.

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

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 Commentary

1996 ◽  
Vol 2 (4) ◽  
pp. 150-150 ◽  
Author(s):  
Steven R. Hirsch
Keyword(s):  
Assertive Community Treatment ◽  
Mentally Ill ◽  
Community Care ◽  
Coping Skills ◽  
Community Treatment ◽  
Community Living ◽  
Open Society ◽  
The Face ◽  
Mental Institution

It is difficult not to be won over by the description of assertive community treatment that promises nearly total caring for the most chronically disabled mentally ill, including “the material essentials of life such as food, clothing and shelter, coping skills necessary to meet the demands of community living and motivation to persevere in the face of life's adversity”. If we keep in mind that this approach is for patients who in previous decades would have spent their life in a mental institution, one can readily justify the transfer of expense and resources to this hopefully more humane form of treatment which allows patients to live within the context of open society, a preference they inevitably opt for when surveyed after a move from hospitalisation to community care.

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.

Family Perspective on Community Treatment Orders: A New Zealand Study

2006 ◽  
Vol 52 (5) ◽  
pp. 469-478 ◽  
Author(s):  
Richard Mullen ◽  
Anita Gibbs ◽  
John Dawson
Keyword(s):  
Family Relationships ◽  
Community Care ◽  
Qualitative Interviews ◽  
Family Members ◽  
Positive Influence ◽  
Community Treatment ◽  
Clinical Team ◽  
Community Treatment Orders ◽  
Family Perspective ◽  
Compulsory Community Treatment

Background: People with serious mental disorders typically live with family members. Despite increasing interest in compulsory community treatment for such patients, the experience and views of their family members have been little studied. Material: Qualitative interviews with 27 family members, whose relatives have been subject to compulsory community treatment. Discussion and conclusions: Family members are generally in favour of the use of compulsory community treatment orders. They perceive a positive influence on their relative, on themselves, on family relationships, and on relations with the clinical team. Family members are aware of the ethical and other dilemmas that attend the use of compulsory community care.

Sign in / Sign up

Export Citation Format

Share Document