Liberty or dignity: community treatment orders and rights

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.

Clinical stability in the community associated with long-term approved leave under the Mental Health Act 2001

“…CTOs were subsequently introduced into England and Wales in November 2008, following the MHA 2007, which added sections 17 A-G to the MHA 1983. This amendment allowed for supervised community treatment and was aimed primarily at those individuals who had repeated involuntary admissions to acute psychiatric units (Woolley, 2010, Lally, 2013. Before the introduction of CTOs, earlier initiatives in the United Kingdom, included extended leave for patients under the MHA 1983 and a 'Supervision Register' on discharge from involuntary status (Sensky et al 1991, Rugkåsa & Burns, 2009).…”

Community treatment orders and mental health social work: Issues for policy and practice in the UK and Ireland

“…A more transparent, legally based form of CTO, with extensive safeguards, it has been argued, should be introduced to the Republic of Ireland to ensure that patients have a right to such forms of care, and control, in the community in order to realise the least restrictive option. A contrary point of view is that the evidence base to support a therapeutic argument for CTOs is difficult to sustain (Lally, 2013) and concerns remain that, if introduced to Ireland 'legislative creep' will occur and excessive, sometimes unregulated use of professional powers become hard to resist.…”