Community treatment orders: international perspective

Mikellides, Georgios; Stefani, Artemis; Tantele, Marianna

doi:10.1192/bji.2019.4

Cited by 5 publications

(10 citation statements)

References 20 publications

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“…The disadvantages mentioned mostly by all stakeholders were that CCT is a coercive measure that it constrains autonomy, and also that it is stigmatizing. Some authors argue on the other hand that CCT can help patients regain their autonomy - and reduces stigma when their stability improves ( 2 ). Another disadvantage all stakeholder groups mentioned, is the excessive focus on taking medication.…”

Section: Discussionmentioning

confidence: 99%

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Use of compulsory community treatment in mental healthcare: An integrative review of stakeholders’ opinions

et al. 2022

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BackgroundMultiple studies have examined the effects of compulsory community treatment (CCT), amongst them there were three randomized controlled trials (RCT). Overall, they do not find that CCT affects clinical outcomes or reduces the number or duration of hospital admissions more than voluntary care does. Despite these negative findings, in many countries CCT is still used. One of the reasons may be that stakeholders favor a mental health system including CCT.AimThis integrative review investigated the opinions of stakeholders (patients, significant others, mental health workers, and policy makers) about the use of CCT.MethodsWe performed an integrative review; to include all qualitative and quantitative manuscripts on the views of patients, significant others, clinicians and policy makers regarding the use of CCT, we searched MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science Core Collection, Cochrane CENTRAL Register of Controlled Trials (via Wiley), and Google Scholar.ResultsWe found 142 studies investigating the opinion of stakeholders (patients, significant others, and mental health workers) of which 55 were included. Of these 55 studies, 29 included opinions of patients, 14 included significant others, and 31 included mental health care workers. We found no studies that included policy makers. The majority in two of the three stakeholder groups (relatives and mental health workers) seemed to support a system that used CCT. Patients were more hesitant, but they generally preferred CCT over admission. All stakeholder groups expressed ambivalence. Their opinions did not differ clearly between those who did and did not have experience with CCT. Advantages mentioned most regarded accessibility of care and a way to remain in contact with patients, especially during times of crisis or deterioration. The most mentioned disadvantage by all stakeholder groups was that CCT restricted autonomy and was coercive. Other disadvantages mentioned were that CCT was stigmatizing and that it focused too much on medication.ConclusionStakeholders had mixed opinions regarding CCT. While a majority seemed to support the use of CCT, they also had concerns, especially regarding the restrictions CCT imposed on patients’ freedom and autonomy, stigmatization, and the focus on medication.

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Section: Discussionmentioning

confidence: 99%

“…Compulsory Community Treatment (CCT) is available as a coercive outpatient treatment option in many countries, including the USA, Canada, Australia, New Zealand, Asia, UK, and the Netherlands ( 1 , 2 ). It is also known as Outpatient Compulsory Treatment or Supervised Community Treatment.…”

Section: Introductionmentioning

confidence: 99%

Use of compulsory community treatment in mental healthcare: An integrative review of stakeholders’ opinions

et al. 2022

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“…As the asylum movement crumbled, community-based treatment facilities gradually came to dominate psychiatric practice. With an increased focus on patient autonomy in medical decision-making and the introduction of Compulsory Community Treatment (CCT; also referred to as mandatory outpatient treatment or assisted outpatient treatment) for psychiatric practice worldwide (such as in the USA, Canada, Australia, New Zealand, Asia, UK, and the Netherlands), there has been renewed interest in this area, but it remains a highly contentious issue [24,25]. The main purpose of courtordered therapy is to provide a less onerous alternative to involuntary admission, and to avoid relapses and readmissions (when there are issues like treatment non-compliance).…”

Section: Introductionmentioning

confidence: 99%

Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review

Laureano,

Laranjeira,

Querido

et al. 2024

Healthcare

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In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical decision-making about involuntary psychiatric treatment. Five databases (Embase, PsycINFO, CINAHL, Medline, and Scopus) were searched for articles on this topic. Out of a total of 342 articles found, 35 studies from 14 countries were included based on the selection criteria. The articles were analyzed using the inductive content analysis approach. The following main categories were identified: (1) ethical foundations that guide clinical decision-making; (2) criteria for involuntary psychiatric treatment; (3) gaps, barriers, and risks associated with involuntary psychiatric treatment; (4) strategies used to reduce, replace, and improve the negative impact of involuntary treatment; and (5) evidence-based recommendations. Most of the selected articles discuss the logic underlying involuntary treatment of the mentally ill, exploring ethical principles such as autonomy, beneficence, non-maleficence, or justice, as well as how these should be properly balanced. During the process of involuntary psychiatric admission, there was a notable absence of effective communication and a significant power imbalance that disenfranchised those seeking services. This disparity was further intensified by professionals who often use coercive measures without a clear decision-making rationale and by family members who strongly depend on hospital admission. Due to the pluralistic and polarized nature of opinions regarding legal capacity and the complexity and nuance of involuntary admission, further studies should be context-specific and based on co-production and participatory research.

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“…Despite intense criticism and ongoing debates regarding mandatory treatments, 1 which highlight the complex challenges they pose across various domains including clinical, ethical, legal, economic, and professional aspects, both the rate of involuntary inpatient admissions 2,3 and involuntary outpatient treatments have increased globally. 4,5 Representing a conflict between the principles of respecting autonomy and of preventing harm to individuals, community treatment order (CTO) is widely used and has been introduced in around 75 jurisdictions worldwide [3][4][5] with the aim of countering low treatment adherence, frequent relapses and controlling risk among people with serious mental illness (SMI). 6,7 The use of community mandatory treatment is widespread across most North American jurisdictions.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, the implementation of CTOs varies in terms of treatment criteria for compulsion, duration, and representing a conflict between the principles of respecting autonomy and of preventing harm to the individuals admission history. 4 However, it can be broadly defined as designed to deliver mental healthcare in the community and constitutes a legal obligation in which Representing a conflict between the principles of respecting autonomy and of preventing harm to the People with SMI must adhere to out-of-hospital treatment plans. 8 The essential philosophy underlying legally mandated community care is that the individual is permitted to remain in the community as long as they adhere to certain conditions of care; most commonly, taking their prescribed medication and maintaining regular contact with their mental health care team.…”

Section: Introductionmentioning

confidence: 99%

The long‐term adherence following the end of Community Treatment Order: A systematic review

Cossu,

Kalcev,

Sancassiani

et al. 2024

Acta Psychiatr Scand

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BackgroundThe community treatment order (CTO) is designed to deliver mental healthcare in the community and has been introduced in around 75 jurisdictions worldwide. It constitutes a legal obligation in which individuals with severe mental illness must adhere to out‐of‐hospital treatment plans. Despite intense criticism and the debated nature of published evidence, it has emerged as a clinical and policy response to frequent hospital readmissions and to enhance adherence in cases where there is refusal of pharmacological treatments. This systematic review outlines findings on CTO long‐term adherence, after mandatory outpatient treatment has ended, in studies that include people with psychiatric disorders.MethodFollowing PRISMA guidelines, we performed a review of published articles from PubMed, PsycINFO, EMBASE, and CINAHL up to January 15, 2023. We included studies that assessed adherence after CTO ends. The study is registered with PROSPERO number CRD42022360879.ResultsSix independent studies analyzing the main indicators of long adherence: engagement with services and medication adherence, were included. The average methodological quality of the studies included is fair. Long‐term adherence was assessed over a period ranging from 11 to 28 months. Only two studies reported a statistically significant improvement. Regarding the remaining studies, no positive correlation was observed, except for certain subgroup samples, while in one study, medication adherence decreased.ConclusionScientific evidence supporting the hypothesis that CTO has a positive role on long‐term adherence post‐obligation is currently not sufficient. Given the importance of modern recovery‐oriented approaches and the coercive nature of compulsory outpatient treatment, it is necessary that future studies ensure the role of CTO in effectively promoting adherence.

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Community treatment orders: international perspective

Cited by 5 publications

References 20 publications

Use of compulsory community treatment in mental healthcare: An integrative review of stakeholders’ opinions

Use of compulsory community treatment in mental healthcare: An integrative review of stakeholders’ opinions

Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review

The long‐term adherence following the end of Community Treatment Order: A systematic review

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