psychiatric patients under compulsion in community has no clinical
benefit, says report
by Angela Hussain
is no evidence that treating psychiatric patients under compulsion
in the community is of clinical benefit, according to a report commissioned
by the Department of Health.
The conclusion is another blow to government’s plans to extend
compulsory powers of detention over the mentally ill. A mental health
bill includes plans to introduce community treatment orders (CTOs)
which would legally enforce patients living in the community to
take their medication, as well as adhere to other conditions.
The House of Lords last month voted for a series of bill amendments,
placing restrictions on the use of CTOs for only previously hospital-detained
“revolving door” patients. Peers also defeated the government
over a number of other key plans contained in the bill.
The Institute of Psychiatry report examined 72 studies into the
use of CTOs in six countries. It claims to be the most comprehensive
review of research into CTOs.
It concluded: “There is currently no robust evidence about
either the positive or negative effects of CTOs on key outcomes,
including hospital readmission, length of hospital stay, improved
medication compliance, or patients' quality of life."
Paul Farmer, chief executive of the mental health charity Mind which
is opposed in principle to CTOs, said the government plans were
"Community treatment orders won't help people at all,”
"They do not improve compliance with medication. They do not
lower incidents of violence or arrest. They do not reduce length
of stays in hospital. They do not prevent re-admissions. But they
will scare vulnerable people away from seeking help when they need
Rowena Daw, vice chair of the 78-member Mental Health Alliance,
said: "The mental health bill proposed the widest powers of
compulsion in the community of anywhere in the Western world. Yet
the government's own research now shows that these orders have at
best mixed results.”
Nevertheless, The Department of Health said there had been positive
reports about the effect of CTOs from New Zealand, Australia, US
and Scotland, which introduced CTOs in 2005.
A spokesperson told the BBC: "Community treatment orders are
a key part of helping to solve the problem of 'revolving door' patients.
"We know that many tragedies in mental health are preceded
by non-compliance with treatment and CTOs will address this."
Professor Louis Appleby, the government's national director for
mental health, also said Oxford University would carry out further
research into how CTOs will work in practice.
The mental health bill is due to be introduced to the House of Commons
Institute of Psychiatry
review on community treatment orders
Feb 28: Peers defeat government
over plans to extend compulsory plans of treatment over mentally
ill - controversial bill now due to go before MPs after Easter
Clinical psychologists should refuse to detain patients, academic
urges - new government law means psychologists will be required
to implement “social control”, argues David Harper
Jan 12: Government set to win
bid to extend compulsion powers over mentally ill, says MP
- "I do not think there will be a major Labour rebellion,"
says Lynne Jones of group of MPs with previous "misgivings”
over mental health bill.
Dec 12, 2006: CTOs do not
work...and that's according to the evidence base - Community
treatment orders will help protect the public from mentally people
who kill, says the government. But what of the evidence for such
do you think? Email your comments on the above
article to the editor using the form below. Selected comments will
© 2001-7 Psychminded Limited. All
about this article