Skip to main content
×
×
Home

Liberty or dignity: community treatment orders and rights

  • J. Lally (a1)
Abstract

The use of community treatment orders (CTOs) remains controversial despite their widespread use in a number of different countries. The focus of a CTO should be on individuals with severe and enduring mental disorders, typically requiring adherence with recommended outpatient treatment in the community and requiring that they allow access to members of the clinical team for the purpose of assessment. There is no current provision for CTOs under Irish mental health legislation, although patients who are involuntarily detained under the MHA 2001 (Ireland) can be granted approved leave from hospital. This provision allows for the patient to be managed in the community setting, though, while technically on leave, they remain as inpatients detained under the MHA 2001 (Ireland). This article describes the use of CTOs and considerations relating to their implementation. There is discussion of the ethical grounds and evidence base for their use. Ethical considerations such as balancing autonomy against health needs and the utilisation of capacity principles need to be weighed by clinicians considering the use of CTOs. Though qualitative research provides some support for the use of CTOs, there remains a clear lack of robust evidence based findings to support their use in terms of hospitalisation rates, duration of illness remission and improved social functioning.

Copyright
Corresponding author
*Address for correspondence: Dr J. Lally, MB, MSc, MRCPsych, Department of Psychiatry, Clinical Science Institute, National University of Ireland, Galway (NUIG), Galway, Ireland. Email john.lally@kcl.ac.uk
References
Hide All
Appelbaum, PS (1994). Almost a Revolution: Mental Health Law & the Limits of Change. Oxford University Press: New York.
Appelbaum, PS (2001). Thinking carefully about outpatient commitment. Psychiatric Services 52, 347350.
Appelbaum, PS (2005). Assessing Kendra's law: five years of outpatient commitment in New York. Psychiatric Services 56, 791792.
Appelbaum, PS, Lidz, CW, Meisel, A (1987). Informed Consent: Legal Theory and Clinical Practice. Oxford University Press: Oxford.
Atkinson, JM, Garner, HC (2002). Least restrictive alternative – advance statements and the new mental health legislation. Psychiatric Bulletin 26, 246247.
Borum, R, Swartz, M, Riley, S, Swanson, J, Hiday, VA, Wagner, R (1999). Consumer perceptions of involuntary outpatient commitment. Psychiatric Services 50, 14891491.
Brophy, L, Ring, D (2004). The efficacy of involuntary treatment in the community. Social Work in Mental Health 2, 157174.
Care Quality Commision (2010). Monitoring the Use of the Mental Health Act in England 2009/10. Care Quality Commision: London, UK.
Care Quality Commission MHA Quality Report (2012). Monitoring the Use of the Mental Health Act in England 2011/12. Care Quality Commision: London, UK.
Churchill, R (2005). International Experiences of Using Community Treatment Orders. Institute of Psychiatry: London.
Collins, AA, Remington, G, Coulter, K, Birkett, K (1996). Depression in schizophrenia: a comparison of three measures. Schizophrenia Research 20, 205209.
Crawford, MJ, Hopkins, W, Henderson, C (2000). Concerns over reform of the Mental Health Act. British Journal of Psychiatry 177, 563.
Crawford, MJ, Gibbon, R, Ellis, E, Waters, H (2004). In hospital, at home, or not at all. Psychiatric Bulletin 28, 360363.
David, A, Buchanan, A, Reed, A, Almeida, O (1992). The assessment of insight in psychosis. British Journal of Psychiatry 161, 599602.
Dawson, J (1991). Community treatment orders. Otaga Law Review 17, 410425.
Dawson, J (2002). Randomised controlled trials of mental health legislation. Medical Law Review 10, 308321.
Dawson, J (2005). Community Treatment Orders: International Comparisons. Faculty of Law, University of Otago: New Zealand.
Dawson, J (2006). Fault-lines in community treatment order legislation. International Journal of Law and Psychiatry 29, 482494.
Dawson, J (2009). Community treatment orders in New Zealand. International Psychiatry 6, 5960.
Dawson, J, Mullen, R (2008). Insight and use of community treatment orders. Journal of Mental Health 17, 269280.
Dawson, J, Romans, S (2001). Uses of community treatment orders in New Zealand: early findings. Australian and New Zealand Journal of Psychiatry 35, 190195.
Dawson, J, Szmukler, G (2006). Fusion of mental health and incapacity legislation. The British Journal of Psychiatry 188, 504509.
Department of Health (2006). Mental Health Bill: Regulatory Impact Assessment. The Stationery Office: London, UK.
Department of Health (2007). Mental Health Act 2007. The Stationery Office: London, UK.
Dressing, H, Salize, H (2004). Compulsory admission of mentally ill patients in European Union member states. Social psychiatry and psychiatric epidemiology 39, 797803.
Fistein, EC, Holland, AJ, Clare, IC, Gunn, MJ (2009). A comparison of mental health legislation from diverse Commonwealth jurisdictions. International Journal of Law and Psychiatry 32, 147155.
Fulford, B, Christodoulou, GN, Stein, DJ (2011). Values and ethics: perspectives on psychiatry for the person. International Journal of Person Centered Medicine 1, 131133.
Gibbs, A, Dawson, J, Ansley, C, Mullen, R (2005). How patients in New Zealand view community treatment orders. Journal of Mental Health 14, 357368.
Girgis, S, Spence, S (2003). Is it worth treating mentally ill roofless people? Schizophrenia Research 60, 284285.
Green, MF (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry 153, 321330.
Grisso, T, Appelbaum, PS (1995a). Comparison of standards for assessing patients’ capacities to make treatment decisions. American Journal of Psychiatry 152, 10331037.
Grisso, T, Appelbaum, PS (1995b). The MacArthur Treatment Competence Study. III: abilities of patients to consent to psychiatric and medical treatments. Law and Human Behaviour 19, 149174.
Heaton, RK, Gladsjo, JA, Palmer, BW, Kuck, J, Marcotte, TD, Jeste, DV (2001). Stability and course of neuropsychological deficits in schizophrenia. Archives of General Psychiatry 58, 2432.
Hiday, VA (2003). Outpatient commitment: the state of empirical research on its outcomes. Psychology Public Policy and Law 9, 832.
Irani, F, Kalkstein, S, Moberg, EA, Moberg, PJ (2011). Neuropsychological performance in older patients with schizophrenia: a meta-analysis of cross-sectional and longitudinal studies. Schizophrenia Bulletin 37, 13181326.
Keefe, RS, Bilder, RM, Davis, SM, Harvey, PD, Palmer, BW, Gold, JM, Meltzer, HY, Green, MF, Capuano, G, Stroup, TS, McEvoy, JP, Swartz, MS, Rosenheck, RA, Perkins, DO, Davis, CE, Hsiao, JK, Lieberman, JA (2007). Neurocognitive effects of antipsychotic medications in patients with chronic schizophrenia in the CATIE trial. Archives of General Psychiatry 64, 633647.
King, M, Barcham, C, Carr, J (2008). Workbook to Support Implementation of the Mental Health Act 1983 as Amended by the Mental Health Act 2007. DH: London.
Kisely, SR, Campbell, LA, Preston, NJ (2005). Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane Database Systematic Review 3, 121.
Kisely, SR, Campbell, LA, Preston, NJ (2011). Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane Database Systematic Review 2, 137.
Koegel, P, Burnam, MA, Farr, RK (1988). The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. Archives of General Psychiatry 45, 10851092.
Lawton-Smith, S, Dawson, J, Burns, T (2008). Community treatment orders are not a good thing. The British Journal of Psychiatry 193, 96100.
Macpherson, R, Molodynski, A, Freeth, R, Uppal, A, Steer, H, Buckle, D, Jones, A (2010). Supervised community treatment: guidance for clinicians. Advances in Psychiatric Treatment 16, 253259.
Manning, C, Molodynski, A, Rugkåsa, J, Dawson, J, Burns, T (2011). Community treatment orders in England and Wales: national survey of clinicians’ views and use. The Psychiatrist 35, 328333.
McEvoy, JP, Apperson, LJ, Appelbaum, PS, Ortlip, P, Brecosky, J, Hammill, K, Geller, JL, Roth, L (1989). Insight in schizophrenia. Its relationship to acute psychopathology. Journal of Nervous and Mental Disease 177, 4347.
McGurk, SR, Twamley, EW, Sitzer, DI, McHugo, GJ, Mueser, KT (2007). A meta-analysis of cognitive remediation in schizophrenia. American Journal of Psychiatry 164, 17911802.
Mental Welfare Commission (2011). A Report Into the Use of Compulsory Community Treatment in Scotland. Mental Health Commission for Scotland: Edinburgh, Scotland.
Moncrieff, J, Smyth, M (1999). Community treatment orders – a bridge too far? Psychiatric Bulletin 23, 644646.
Mullen, R, Gibbs, A, Dawson, J (2006). Family perspective on community treatment orders: a New Zealand study. International Journal of Social Psychiatry 52, 469478.
Munetz, MR, Galon, PA, Frese, FJ III (2003). The ethics of mandatory community treatment. Journal of the American Academy of Psychiatry and the Law 31, 173183.
Munoz, M, Vazquez, C, Koegel, P, Sanz, J, Burnam, MA (1998). Differential patterns of mental disorders among the homeless in Madrid (Spain) and Los Angeles (USA). Social Psychiatry and Psychiatric Epidemiology 33, 514520.
Nelson, EA, Maruish, ME, Axler, JL (2000). Effects of discharge planning and compliance with outpatient appointments on readmission rates. Psychiatric Services 51, 885889.
NHS Information Centre (2012). Inpatients formally detained in hospitals under the Mental Health Act 1983 and patients subject to supervised community treatment – England, 2011–2012. Annual figures, England.
NHS Information Centre, For Health and Social Care (2009). In-patients formally detained in hospitals under the Mental Health Act 1983 and patients subject to supervised community treatment: 1998–99 to 2008–09. The Health and Social Care Information Centre.
O'Reilly, R (2004). Why are community treatment orders controversial? Canadian Journal of Psychiatry 49, 579584.
O Reilly, RL, Keegan, DL, Elias, JW (2000). A survey of the use of community treatment orders by psychiatrists in Saskatchewan. Canadian Journal of Psychiatry 45, 7981.
O'Reilly, RL, Keegan, DL, Corring, D, Shrikhande, S, Natarajan, D (2006). A qualitative analysis of the use of community treatment orders in Saskatchewan. International Journal of Law and Psychiatry 29, 516524.
Phelan, JC, Sinkewicz, M, Castille, DM, Huz, S, Muenzenmaier, K, Link, BG (2010). Effectiveness and outcomes of assisted outpatient treatment in New York state. Psychiatric Services 61, 137143.
Pinfold, V, Bindman, J (2001). Is compulsory community treatment ever justified? Psychiatric Bulletin 25, 268270.
Power, P (1999). Community treatment orders: the Australian experience. The Journal of Forensic Psychiatry 10, 915.
Romans, S, Dawson, J, Mullen, R, Gibbs, A (2004). How mental health clinicians view community treatment orders: a national New Zealand survey. Australian and New Zealand Journal of Psychiatry 38, 836841.
Russell, BJ (2011). How research ethics’ protections can contribute to public policy: the case of community treatment orders. International Journal of Law and Psychiatry 34, 349353.
Saks, ER (2002). Refusing Care: Forced Treatment and the Rights of the Mentally Ill. University of Chicago Press: Chicago, USA.
Schwartz, K, O'Brien, A, Morel, V, Armstrong, M, Fleming, C, Moore, P (2010). Community treatment orders: the service user speaks exploring the lived experience of community treatment orders. International Journal of Psychosocial Rehabilitation 15, 3950.
Spence, S, Stevens, R, Parks, R (2004). Cognitive dysfunction in homeless adults: a systematic review. Journal of the Royal Society of Medicine 97, 375379.
Steadman, HJ, Gounis, K, Dennis, D, Hopper, K, Roche, B, Swartz, M, Robbins, PC (2001). Assessing the New York City involuntary outpatient commitment pilot program. Psychiatric Services 52, 330336.
Stefan, S (1987). Preventive Commitment: The Concept and its Pitfalls. V s.n.: Westport, CT.
Swanson, JW, Swartz, MS, Borum, R, Hiday, VA, Wagner, HR, Burns, BJ (2000). Involuntary out-patient commitment and reduction of violent behaviour in persons with severe mental illness. British Journal of Psychiatry 176, 324331.
Swartz, MS, Swanson, JW (2004). Involuntary outpatient commitment, community treatment orders, and assisted outpatient treatment: what's in the data? Canadian Journal of Psychiatry 49, 585591.
Swartz, MS, Swanson, JW, Steadman, HJ, Robbins, PC, Monahan, J (2009). New York State Assisted Outpatient Treatment Program Evaluation. Duke University School of Medicine: Durham, NC.
Swartz, MS, Swanson, JW, Wagner, HR, Burns, BJ, Hiday, VA, Borum, R (1999). Can involuntary outpatient commitment reduce hospital recidivism? Findings from a randomized trial with severely mentally ill individuals. American Journal of Psychiatry 156, 19681975.
Swartz, MS, Swanson, JW, Wagner, HR, Hannon, MJ, Burns, BJ, Shumway, M (2003). Assessment of four stakeholder groups’ preferences concerning outpatient commitment for persons with schizophrenia. American Journal of Psychiatry 160, 11391146.
Vollmann, J, Bauer, A, Danker-Hopfe, H, Helmchen, H (2003). Competence of mentally ill patients: a comparative empirical study. Psychological Medicine 33, 14631471.
Wahl, OF (1995). Media Madness: Public Images of Mental Illness. Ruther University Press: New Brunswick, NJ.
Weiden, PJ, Kozma, C, Grogg, A, Locklear, J (2004). Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatric Services 55, 886891.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Irish Journal of Psychological Medicine
  • ISSN: 0790-9667
  • EISSN: 2051-6967
  • URL: /core/journals/irish-journal-of-psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed