How patients in New Zealand view community treatment orders

Gibbs, Anita; Dawson, John; Ansley, Chris; Mullen, Richard

doi:10.1080/09638230500229541

Cited by 81 publications

(74 citation statements)

References 16 publications

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“…A 60-year-old with a diagnosis of major depressive disorder said, "I was pretty much into selfharm and attempting suicide. I don't think I would be here now if I wasn't on [conditional release]" (19).…”

Section: T Ta Ab Bl Le E 4mentioning

confidence: 99%

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Effect of Conditional Release From Hospitalization on Mortality Risk

Segal¹,

Burgess²

2006

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Section: T Ta Ab Bl Le E 4mentioning

confidence: 99%

“…Typical comments included: 'It's more beneficial than an in-patient order'; 'It's better to be in the community than in hospital, there's much more freedom' " (19).…”

Section: Effect Of Conditional Release From Hospitalization On Mortalmentioning

confidence: 99%

Effect of Conditional Release From Hospitalization on Mortality Risk

Segal¹,

Burgess²

2006

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“…Indeed, many consumers attribute their clinical improvement to the improved quality of care they experienced under a CTO. 24 There is general acceptance of the use of CTOs for beneficial purposes, where there were psychiatric problems, lack of insight, or risk.25 Many consumers prefer CTOs to hospital care, criminal justice settings or homelessness, although in contrast, they are aggrieved at the loss of control over their circumstances. 26 The literature also indicates that the experience of CTOs involves a tension between the undesirable sense of coercion and loss associated with such orders, and the benefits of improved clinical state, psychosocial function, and access and engagement with treatment services.8,9 Research on coercion emphasises that this tension is complex: coercion is a context-dependent process that requires rich and nuanced description to be better understood;27,28 and that any potential benefits, and therefore justification, may be eroded by how it is implemented in practice.…”

mentioning

confidence: 99%

The lived experience of involuntary community treatment: a qualitative study of mental health consumers and carers

Light

Robertson

Boyce

et al. 2014

Australas Psychiatry

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Objective: To describe the lived experiences of people subject to community treatment orders (CTOs) and their carers.\ud \ud Method: We recruited 11 participants (five mental health consumers and six carers) through consumer and carer networks in NSW, Australia, to take part in interviews about their experiences. We analysed the interview data set using established qualitative methodologies.\ud \ud Results: The lived experiences were characterised by ‘access’ concerns, ‘isolation’, ‘loss and trauma’, ‘resistance and resignation’ and ‘vulnerability and distress’. The extent and impact of these experiences related to the severity of mental illness, the support available for people with mental illnesses and their carers, the social compromises associated with living with mental illness, and the challenges of managing the relationships necessitated by these processes.\ud \ud Conclusions: The lived experience of CTOs is complex: it is one of distress and profound ambivalence. The distress is an intrinsic aspect of the experience of severe mental illness, but it also emerges from communication gaps, difficulty obtaining optimal care and accessing mental health services. The ambivalence arises from an acknowledgement that while CTOs are coercive and constrain autonomy, they may also be beneficial. These findings can inform improvements to the implementation of CTOs and the consequent experiences.\ud \ud Keywords: carer, community treatment order, interview, involuntary treatment, mental health, patient experience, qualitative researchsupported by the Mental Health, Drug and Alcohol Office (MHDAO) of NSW Health of Australia

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“…perception of coercion [26][27][28] and the impact on the therapeutic alliance and quality of life should also be examined. Because CTOs involve formal (providers) and informal (families) systems, measures of satisfaction need to involve not only the person subject to a CTO but also other stakeholders.…”

mentioning

confidence: 99%

Community Treatment Orders in Toronto: The Emerging Data

et al. 2007

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Objective: Over a 4-year period in Toronto, this study aimed to compare individuals on a community treatment order (CTO) with individuals not on a CTO in terms of sociodemographic and clinical variables, hospital use, and continued engagement with health services on exit from the case management program. Hospital stay reductions from preadmission into the program to various postadmission periods were compared across the 2 groups. Methods:Descriptive statistics and tests of statistical significance (chi-square and t test) were run on regularly collected administrative data for both groups.Results: Categorical data analysis indicated the 2 groups were statistically similar on a range of sociodemographic and clinical variables. Although both groups displayed reductions in hospital use, the CTO group displayed a significantly higher reduction in cumulative days in hospital per hospital admission within both the first and second 6-month period postadmission. This same group also had significantly greater reduction in hospital admissions during the second 6-month period postadmission. The CTO group also had a significantly higher portion of individuals exiting the program within these first two 6-month periods; as well, they were less likely to exit with support such as case management or assertive community treatment and more likely to continue with ongoing medical supervision than the comparison group. Conclusion:Although we were unable to rule out regression to the mean for hospitalization reductions, the Toronto experience has shown that CTOs are helpful in assisting individuals who historically refused services to remain engaged with treatment and support services. The study also calls for broadening operational measures of outcomes for CTO studies. Clinical Implications· CTOs may be helpful in increasing continued engagement with treatment services after the CTO has expired. · CTOs are associated with reductions in hospital admissions and lengths of stay. · Evaluating the benefits of CTOs requires a broad range of outcome measures. Limitations· Sample sizes differed between the comparison and experimental groups. · There was a lack of randomization to groups for comparison. · Internal threats to validity existed, such as selection bias and regression to the mean.

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How patients in New Zealand view community treatment orders

Abstract: The usefulness of community treatment orders is accepted by most patients under them in NZ, as well as by most psychiatrists. Critical factors include the quality of therapeutic relationships and the structure provided for community mental health care.

Cited by 81 publications

References 16 publications

Effect of Conditional Release From Hospitalization on Mortality Risk

Effect of Conditional Release From Hospitalization on Mortality Risk

The lived experience of involuntary community treatment: a qualitative study of mental health consumers and carers

Community Treatment Orders in Toronto: The Emerging Data

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