COMING TO NEW BRUNSWICK: COMMUNITY TREATMENT ORDERS?

          Community Treatment Orders or CTO’s have been instituted in Saskatchewan, Manitoba, British Columbia, and Ontario and there is a movement afoot to bring them to New Brunswick.  Internationally, CTO’s are law in 41 states of the U.S., in Austrailia, New Zealand, and the United Kingdom.  The goal of CTO’s are to provide seriously ill mental health consumers with a less restrictive treatment than being detained in a hospital or held in the legal system.  The patient is treated in their home

and is followed by a mental health professionals.

THE CRITERIA

    The criteria for patients being put on CTO’s is the following:

1.      a prior history of hospitalization

2.      a CTO plan is in place

3.      the patient has seen a doctor within the last 72 hours of a CTO

4.      the patient’s ability to comply

5.      consultation with the patient or the patient’s decision maker

6.      consent to have a CTO

BENEFITS AND WARNINGS

     An interesting article on “Community Treatment Orders: International Comparisons” by John Dawson at Otago University in New Zealand comments that there are, “… significant therapeutic benefits for the patients; greater compliance with outpatient treatment, especially medication; and reduced rates of hospital admissions.”  However, the same study points out that, “CommTO’s are strongly linked to the use of depot (or inject able) medication, which is disliked by many patients, and patients commonly complain that their treatment is dominated by the use of medication, with little access to other therapies.  CommTO’s tend to be issued for the maximum period permitted by law and discharge is likely to occur shortly before an independent review hearing would be held.  When the patient’s treatment is proceeding satisfactorily, clinicians seem to have a strong preference for maintaining the status quo, so discharge from the order may not be easy for patients to obtain.”

     In Canada, most CTO’s are issued for six months at a time.  Theoretically, they can be rescinded by one of three conditions: 1. by the doctor at the request of the patient or her decision maker 2. non-compliance of the patient or 3. the withdrawal of consent of the patient or the patient’s decision maker.

     Although there are benefits to CTO’s, John Dawson warns that, “Clinicians should avoid assuming that all patients on CommTO’s must be administered medication by injection.  CommTO’s should not be over-used for patients with affective (mood) disorders, for whom their efficacy is uncertain, and whose capacity to consent may swiftly return after their initial treatment.  Nor should CommTO’s be over-used when there is extreme pressure on hospital beds.”  CTO’s have been found most effective in those patients who have psychotic disorders.

     CTO’s may provide a good alternative to jail or psychiatric hospitals in New Brunswick.  However, the cautions put forth by New Zealand’s experience should be kept in mind.