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can be rescinded by one of three conditions: 1.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 New Zealand ’s
experience should be kept in mind.
