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>

The Relationship of Schizophrenic Births to 16 Infectious Diseases

1994 ◽  
Vol 165 (3) ◽  
pp. 353-356 ◽  
Author(s):  
E. O'Callaghan ◽  
P. C. Sham ◽  
N. Takei ◽  
G. Murray ◽  
G. Glover ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Poisson Regression ◽  
The Other ◽  
Data Sets ◽  
Poisson Regression Model ◽  
England And Wales ◽  
Schizophrenic Patients ◽  
Relationship Of ◽  
The Relationship ◽  
First Admission

BackgroundRecently, several investigators have reported an association between influenza epidemics and increased birth rates of ‘preschizophrenic’ individuals some four to six months later. Here we examine whether maternal exposure to other infectious diseases can also predispose the foetus to later schizophrenia.MethodTwo independent sets of dates of birth of first admission schizophrenic patients, born between 1938 and 1965 in England and Wales, were obtained from the Mental Health Enquiry in England and Wales. Data on the number of deaths per month from 16 infectious diseases between 1937 and 1965 in England and Wales were also collected. We used a Poisson regression model to examine the relationship between deaths from infectious diseases and schizophrenic births.ResultsIn the two separate data sets, increased national deaths from bronchopneumonia preceded, by three and five months respectively, increased numbers of schizophrenic births. We did not find any other significant associations between schizophrenic births and any of the other 15 infectious diseases.ConclusionsThe association between deaths from bronchopneumonia and increased schizophrenic births some months later may be a reflection of the fact that bronchopneumonia deaths increase markedly during influenza epidemics.

scholarly journals Community Treatment Orders

2014 ◽  
Vol 1 (16) ◽  
pp. 149
Author(s):  
Kris Gledhill
Keyword(s):  
Mental Health ◽  
Revolving Door ◽  
Community Treatment ◽  
Patient Treatment ◽  
England And Wales ◽  
Mental Health Act ◽  
Heated Debate ◽  
Policy Objectives ◽  
Treatment Order ◽  
Community Treatment Order

<p>A community treatment order is now a well-established feature of various common law jurisdictions in North America and Australasia, and in other countries. Its introduction into England and Wales was a central part of the government’s drawn out reform of the Mental Health Act 1983, and it attracted heated debate as part of the Parliamentary process, both in the exchanges between Parliamentarians and the evidence and briefings filed by interested parties. A CTO provision was introduced with a speedier gestation period in Scotland. But there is no single form of “community treatment order”; and there may also be different policy objectives. What is usually central is the desire to provide a regime for patients who are assessed as being able to function in the community so long as they accept medication but who may disengage from treatment and relapse to the extent that they require in-patient treatment: the description “revolving door” is often attached to such patients and was during the course of the debates.</p><p>The first question to be explored is whether what emerged in the Mental Health Act 2007 is much different from what already exists in relation to such patients: if it is and it allows community treatment which was previously not available, the further question is whether that is a good thing in light of the experience of other jurisdictions that have CTO regimes. If it is not, there are two further questions: firstly, why has something called a CTO been introduced if it does not amount to a change of substance; and secondly, is it a missed opportunity in light of the information from other jurisdictions – in other words, would a substantive change provide benefits which England and Wales is now missing?</p>

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 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 Compulsion in the community? The introduction of supervised community treatment

2010 ◽  
Vol 16 (4) ◽  
pp. 245-252 ◽  
Author(s):  
Guy Brookes ◽  
Nick Brindle
Keyword(s):  
Mental Health ◽  
Health Professionals ◽  
Community Treatment ◽  
Mental Health Practitioners ◽  
England And Wales ◽  
Mental Health Act ◽  
Health Practitioners ◽  
Legislative Framework

SummarySupervised community treatment (SCT) is one of the most prominent amendments to the Mental Health Act 1983. It has divided opinion among health professionals and introduces significant powers not previously available in England and Wales. This article considers how SCT fits into the established legislative framework and how it may affect the care delivered by mental health practitioners.

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 Does compulsory or supervised community treatment reduce ‘revolving door’ care?

2007 ◽  
Vol 191 (5) ◽  
pp. 373-374 ◽  
Author(s):  
Stephen Kisely ◽  
Leslie Anne Campbell
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Epidemiological Studies ◽  
Previous Literature ◽  
Revolving Door ◽  
Community Treatment ◽  
England And Wales ◽  
Mental Health Act

SummarySupervised community treatment to address ‘revolving door’ care is part of the new Mental Health Act in England and Wales. Two recent epidemiological studies in Australia (n > 118 000), as well as a systematic review of all previous literature using appropriately matched or randomised controls (n = 1108), suggest that it is unlikely to help.

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.

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.

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.

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