There is very little evidence to suggest that CTOs are associated with any positive outcomes and there is justification for further research in this area.
Well the psychiatric ASBO otherwise known as Community Treatment Orders (CTOs) has been ushered in today along with other changes to the Mental Health Act. And Royal College of Psychiatrists (and it seems the RCP have done a volte-face as they were originally very nervous towards the introduction of CTOs) and mental health Tsar, Louis Appleby are welcoming the changes.
Will these changes ensure better care for a minority of patients who, because of illness, stop taking their medication and are therefore vulnerable and at risk…?
What are the safeguards? And what about rights and principles. Who will make the decisions? Will someone on a CTO be allowed to appeal? How will the CTOs be monitored? Who will do the monitoring? Where is the accountability and transparency? It is one continuous attack on civil liberties, self-determination and autonomy.
The implications are that psychiatrists will be over-zealous in applying a CTO under the belief that it will be better to be safe than sorry and err on the side of caution. It is sugar coating CTOs to make them more palatable to swallow and they are nothing more than psychiatric ASBOs.
The government claim that around 1,450 will be placed on CTOs yet according to research by the King’s Fund it is estimated that there will be a gradual year on increase of numbers. They believe it is more likely that between 7,000-13,000 service users could be placed on CTOs over the next 10-15 years.
At the moment young Black men are 38% more likely than the average to be sectioned under the current Mental Health Act and with the lack of safeguards this disproportionate number of Black people being forced onto CTOs will remain.
The psychiatric system reflects the sexism, racism and homophobia that exists in this society and without any kind of anti-discrimination this will continue (though there was an amendment regarding this but New Labour ditched it). In March 2007, research commissioned by the Dept of Health stated:
This review has found very little evidence of positive effects of CTOs in the areas where they might have been anticipated. None of the nine experimental studies found evidence suggesting that CTOs reduce either hospital readmission or length of stay, or that they improve compliance. (Rachel Churchill – International Experiences of Community Treatment Orders).
Even New Labour’s mental health Tsar, Louis Appleby, admitted that the review had not reliably demonstrated the effectiveness of CTOs… Yes, the same Louis Appleby in today’s Guardian letters page…
CTOs are a way, New Labour claims, of reducing psychiatric admissions yet studies have shown in Australia, that CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were all associated with increased admission rates. The authors conclusion stated that we should question the rationale for CTOs and advocate more effective treatments. (British Journal of Psychiatry, 2004).
The Institute Of Psychiatry’s International experiences of using CTOs (March 2007) noted as well that ethnicity data from Israel, USA, New Zealand and Australia, indicate that relative to the proportion of the general population comprised by their ethnic group, most ethnic groups might be over-represented amongst CTO recipients.
The Mental Health Act can be reduced to the 3 C’s of New Labour (compulsion, coercion, containment). It is a retrograde act and will terrify mental health service users. It will destroy trust between service user and professional. Instead of support service users will feel policed. If a person can live in the community then they should be trusted in whether they take their medication. It is about choice. And surely the service user is the best person to know whether medication works or doesn’t work? And if the service user is experiencing dire side-effects are they expected to keep taking it?
Mental health service users already, for good reason, feel stigmatised and victimised and this Act will only increase that fear. One of the biggest criticisms from mental health service users (and from my own personal experience I echo it) is not being listened to and your needs, demands, concerns regularly ignored by professionals this will indeed create more powerlessness and lack of control over your surroundings. This will add to the distress and will in no way increase better mental health.
The Act with its changes, along with agenda of New Labour, attacks civil liberties and will instil fear, stigma, mistrust and create a tightly controlled passive society…..