Community treatment orders – a bridge too far?

Joanna Moncrieff,Marceleno Smyth

doi:10.1192/pb.23.11.644

Abstract

Compulsory treatment in the community is high on the agenda in the current review of mental health legislation and the government has already announced its intention to introduce a ‘community treatment order’ (CTO; Department of Health, 1998). Concern about the implications of community care has been gathering momentum over the last decade, spurred on by tragedies such as those involving Ben Silcock and Christopher Clunis in the early 1990s. The notion that community care has failed has taken deep root with the media and the government (Department of Health, 1998). This is despite the lack of any evidence to suggest that mental illness is less effectively treated (Johnstone et al, 1991; Anderson et al, 1993) or that violence attributable to the mentally ill is rising (Taylor & Gunn, 1999). It also indicates a tendency to ignore the fact that patients prefer to live in the community (Tyrer, 1998). Psychiatrists, who are increasingly implicated in this purported failure of care, feel besieged. In such a climate, the promise of more power is understandably attractive. However, we feel that psychiatrists should resist pressure for this sort of ‘quick fix’ and reflect upon some of the dilemmas involved.

Highlights

Compulsory treatment in the community is high on the agenda in the current review of mental health legislation and the government has al r'ceoamdymuannitnyountcreeadtmenitts ionrtdeenrt'ion(CTtOo; iDnetrpoadrutmceent a of Health, 1998)
CTOs will mean that people who are living and surviving in the community, who have com mitted no crime, and who are deemed competent enough to marry, vote and enter into business contracts, will be deprived of certain basic human rights enjoyed by the rest of the popula tion
By differentiating between the human rights of people who have been psychiatric patients and the rest of the population, CTOs will add to the stigma attached to the notion of mental illness which the Royal College of Psychiatrists is trying, laudably, to combat (Byrne, 1999)

Summary

Joanna Moncrieff and Marceleno Smyth

Compulsory treatment in the community is high on the agenda in the current review of mental health legislation and the government has al r'ceoamdymuannitnyountcreeadtmenitts ionrtdeenrt'ion(CTtOo; iDnetrpoadrutmceent a of Health, 1998). The notion that community care has failed has taken deep root with the media and the government (Department of Health, 1998). This is despite the lack of any evidence to suggest that mental illness is less effectively treated (Johnstone et al 1991; Ander son et al, 1993) or that violence attributable to the mentally ill is rising (Taylor & Gunn, 1999). Psychiatrists, who are increasingly im plicated in this purported failure of care, feel besieged. In such a climate, the promise of more power is understandably attractive. We ftheeisl tshoartt posfyc'qhuiaictrkistsfix' sahnoduldreflreecstistuppornesssuorme e foorf the dilemmas involved

Ethical objections

Practical objections

Harmful effects

Greg Wilkinson and Tom Brown