Ethical Issues for Community Treatment Orders

Ekta Patel

“Community Treatment Orders” refer to a legal order in which patients must accept medical care such as therapy, rehabilitations, management or coping classes, counselling or other health services while living in the public. The Community Treatment Order (CTO) accounts to serve patients with psychiatric treatment plans that are essentially established by the patient’s psychiatric health provider. The CTO requires patients to comply with all conditions and terms of the order, hence, if not followed, they would be directed to a psychiatric health facility where essential care and treatment would be initiated. CTO can be prepared for any time period – for up to twelve months. This means that patients may have to comply with CTOs for more than just one sequential time.

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Section 7 on the Canadian Charter Rights of Freedom, under the Mental Health Legislation, it states that life, liberty and security of all citizens are fundamental principles of justice. Notwithstanding, ethical concerns arise because these rights of people are jeopardized with the forceful commitment and acceptance that psychiatric patients have to conform to when CTOs come to play.

There have been ethical controversies associated with the implementation of CTOs along with other forms of outpatient treatment regulations. The debate on the suitable mandatory care in the community reflects the unstable political, philosophical, and medical concerns. With the involuntary Community Treatment Orders options, it is said to “force” treatment amongst individuals seeking care, hence taking away their rights of having a choice. In short, CTOs place patient autonomy at risk.

The debate argues that this forceful treatment takes away the right of individuals to refuse treatment for a psychiatric illness. This argument of limiting freedom amongst individuals with disturbances is not recent; it has been a targeted issue since the 1960s through the 1970s. During the 1960s and 1970s the debate largely focused on the quarrel of involuntary inpatient treatment and care. However, at present, the debate focuses on community based treatment, arguing that CTOs serve to stop involuntary medical attention.

With the implementation of CTOs, are several associated arguments. Firstly, CTO being involuntary, it breaks the norm of never forcing treatment amongst individuals. CTO aggravates forceful actions into the community. The implementation of CTO intensifies the struggle of defending patient rights within the community, thus neglecting other possible services that could be far more optimal in treating patients. Thirdly, we all know that the overflow of inpatients and wait-times in health care facilities have become a prime concern, and with the execution of CTOs, hospitals will be far more packed with non-adherent patients. Consequently, this reinforces long wait-times in Emergency Departments and causes in-patient beds to be occupied more frequently, therefore delaying and interrupting the quality of health services and care for other patients.

From the perspective of psychic, Uri Geller, “come people are deprived of their liberties in the attempt to give them psychiatric care. Occasionally, others are deprived of psychiatric care in the attempt to guard their liberties”. Supporters of CTOs argue that when people with psychological disturbances are given liberty, they could potentially become marginalized from getting crucial treatment required to benefit their health. Though this idea to some extent is accurate, there is a much riskier adverse effect associated with it. This is because, when patients are involuntarily treated for the specified amount of time chosen by psychiatrics, patients are required to take regular doses of antipsychotic medications. As a result of this, it can lead to severe long-term or short-term harmful side effects.

Community Treatment Orders have illustrated to reduce the number of victimized patients of abuse. CTO is a form of epistemic violence, because it involves ignoring individual’s perspective, while declaring they are too “sick” to have a say. The implementation of CTOs is significantly increasing, but it is argued that the result of CTOs does not validate the constraints that are compiled on a patient’s autonomy. Reason being, although coerce CTOs make the public feel secure and safe, it violates those, who are suffering from psychiatric imbalances. This is because, they are not given the liberty and the right to choose what type of treatment and care they would like to seek and are discriminated against.

According to a randomized controlled trial, it was found that the number of patients readmitted did not differ as much between patients. Hence, it can be concluded that compulsory orders do not reduce the rate of hospital re-admission of psychiatric consumers. There is limited evidence that proves that compulsory community treatments, including CTOs have achieved its medical goals, which was to decrease re-hospitalisation and increase attention towards medication and medical services.  Instead, to improve community-based psychiatric services, psychiatrics or other medical specialists could arrange for regular patient testing, for example, frequent urine, and blood. This can help specialists to have adequate patient information, allowing them to precisely determine optimal treatment plans.

References

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Canadian Civil Liberties Association. (2015). Talking About Community Treatment Orders and Discrimination. Retrieved from https://ccla.org/talking-about-community-treatment-orders-and-discrimination/

Dreezer, S., Bay, M., Hoff, D., Microlog (2007). Dreezer & Dreezer Inc., & Ontario Ministry of Health and Long-Term Care & Ebrary CEL – York University, Report on the legislated review of community treatment orders, required under section 33.9 of the Mental Health Act. [Toronto, Ont.]: Ontario Ministry of Health and Long-Term Care.

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Steve, K., Katherine, H. (2014). An Updated Meta-Analysis of Randomized Controlled Evidence for the Effectiveness of Community Treatment Orders. The Canadian Journal of Psychiatry. Pages 1-4 http://journals.sagepub.com/doi/abs/10.1177/070674371405901010