How research ethics' protections can contribute to public policy: The case of community treatment orders

Russell, B

doi:10.1016/j.ijlp.2011.08.007

Cited by 2 publications

(1 citation statement)

References 24 publications

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“…Individuals with a mental disorder, who are considered to be a risk for the safety of others, are also treated under CTOs through paternalism, and indeed it is arguably this risk criterion that has driven a large amount of CTO legislation worldwide, as exemplified by Kendra's Law in New York state (Appelbaum, 2005), Brian's Law in Ontario, Canada, and Laura's Law in California, USA (Russell, 2011). The overemphasis on the risk criterion as a prerequisite for CTOs (Fistein et al 2009) might also foster a strong public perception of mentally ill individuals as being generally unpredictable or dangerous, thus contributing to their stigmatisation (Wahl, 1995) and an increased risk of discrimination (Fistein et al 2009).…”

Section: Ethical Considerationsmentioning

confidence: 99%

Liberty or dignity: community treatment orders and rights

Lally

2013

Ir. j. psychol. Med.

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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.

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