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

Progressive Reforms ◽

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

Uses of Community Treatment Orders in New Zealand: Early Findings

Australian & New Zealand Journal of Psychiatry ◽

10.1046/j.1440-1614.2001.00873.x ◽

2001 ◽

Vol 35 (2) ◽

pp. 190-195 ◽

Cited By ~ 25

Author(s):

John Dawson ◽

Sarah Romans

Keyword(s):

New Zealand ◽

Community Care ◽

Significant Proportion ◽

Community Treatment ◽

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.

Carer experience of Community Treatment Orders: implications for rights based/recovery-oriented mental health legislation

Australasian Psychiatry ◽

10.1177/1039856214568216 ◽

2015 ◽

Vol 23 (2) ◽

pp. 154-157 ◽

Cited By ~ 8

Author(s):

Ruth Vine ◽

Angela Komiti

Keyword(s):

Mental Health ◽

Community Treatment ◽

Involuntary community treatment in New South Wales, Australia

Psychiatric Bulletin ◽

10.1192/pb.19.1.45 ◽

1995 ◽

Vol 19 (1) ◽

pp. 45-47 ◽

Cited By ~ 4

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 ◽

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.

Reform or Revolution? Mental Health Legislation and the Development of Community Care

Mental Health Services and Community Care ◽

10.46692/9781447350637.006 ◽

2020 ◽

pp. 73-94

Keyword(s):

Mental Health ◽

Community Care ◽

Coercion in Community Mental Health Care

10.1093/med/9780198788065.001.0001 ◽

2016 ◽

Cited By ~ 5

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Mentally Ill ◽

Community Care ◽

Current Knowledge ◽

Community Services ◽

Community Treatment ◽

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

Jurisdiction of Mental Health Tribunals to Provide Positive Remedies: Application, Challenges, and Prospects

McGill Law Journal ◽

10.7202/1007817ar ◽

2012 ◽

Vol 57 (2) ◽

pp. 267-298

Author(s):

Joaquin Zuckerberg

Keyword(s):

Mental Health ◽

Health Care ◽

Civil Rights ◽

Mentally Ill ◽

Policy Makers ◽

Adequate Care ◽

The Right ◽

Health Legislation ◽

State Interference

Modern mental health legislation protects the civil rights of the mentally ill by limiting the scope of permissible state interference with an individual’s autonomy. It also generally sets up mental health tribunals in charge of reviewing compliance with parts of the legislation. However, the legislation does not generally address the right to adequate mental health care. The latter (or its lack thereof) has increasingly become a source of debate among scholars and policy makers. The right to adequate care is increasingly being seen as the sine qua non of the civil rights of the mentally ill. This article explores recent Canadian jurisprudence dealing with the power of administrative tribunals to address constitutional and quasi-constitutional claims, and questions whether such power could give rise to a claim for adequate health care before mental health tribunals. It argues that, subject to some limited circumstances where mental tribunals have been given certain discretion to factor adequate care into their decisions, the recent Canadian jurisprudence does not significantly modify the limited remedies available before mental health tribunals.

New World of Mental Health Legislation England and Wales David Jolley and Reinhard Heun

European Psychiatry ◽

10.1016/s0924-9338(09)70393-1 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

D. Jolley ◽

R. Heun

Keyword(s):

Mental Health ◽

Mental Disorder ◽

Mental Illnesses ◽

Community Treatment ◽

List Type ◽

Type Number ◽

England And Wales ◽

Use Of Resources ◽

After eight years of tortured negotiations between government, professional psychiatrists and lay pressure groups, England and Wales will begin to use new Mental Health Legislation November 2008. This will not be a new Mental Health Act, but a substantial modification of the 1983 act. There are nine key changes:1.A single definition of mental disorder: ‘any disorder of mind or brain’.2.Criteria for compulsion: ‘appropriate medical treatment’ test.3.Age-appropriate services: special arrangements for under 18 years.4.Professional roles: approved clinicians and responsible clinicians (non-medical).5.Nearest relative: recognises Civil Partnerships, allows displacement.6.Supervised Community Treatment Orders.7.Mental health Review Tribunal: unified.8.Advocacy: Independent Mental Health Advocates.9.ECT: new safeguards.The Code of Practice identifies five key principles:1.Purpose - to minimise adverse effects of Mental Disorder.2.Least Restriction.3.Respect - diverse needs, values and circumstances.4.Participation - involving patient in planning, developing and reviewing treatment and care.5.Effectiveness, efficiency and equity - optimal use of resources.Earlier drafts had been described as: ‘little more than a Public Oder Bill dressed up as Mental Health legislation’; ‘ethically unworkable and practically unworkable’. Much of the dissent related to suggestions that people with Personality Disorder behaving in a dangerous or antisocial way should be subject to compulsory detention. Fears included breach of liberties and Human Rights and transformation of Mental Health Services disadvantaging people with major mental illnesses.

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

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v13i3.17 ◽

2007 ◽

Vol 13 (3) ◽

pp. 3

Author(s):

Lord Patel Of Bradford ◽

Chris Heginbotham

Keyword(s):

Mental Health ◽

Human Rights ◽

Mental Disorder ◽

Community Treatment ◽

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>