Authors: Tim Rolfe
Event: 2002 TheMHS Conference
Subject: Western australia, WA, psychiatry, book of proceedings
Type of resource: Conference Presentations and Papers
Abstract: Community Treatment Orders (CTOs) were introduced to Western Australia as part of the Mental Health Act 1996. Most states and territories in Australia and a number of jurisdictions in the USA, Canada, New Zealand and more recently the UK have introduced the concept of the involuntary patient who resides in the community rather than in an institution. Involuntary treatment as part of mental health legislation has been the most consistently debated issue in mental health law and much of the focus has been on CTOs which extend the mental health service's supervisory control over people with a mental illness into the community. From one perspective CTOs are seen as the logical alternative to inpatient incarceration as it maintains people with a mental illness in the community where before due to lack of insight, non-compliance with medication and relapse they were routinely readmitted to hospital. Therapeutic jurisprudence (TJ) is the study of law as a social force, which may produce therapeutic or anti-therapeutic consequences. In relation to mental health law TJ inquires into whether or not CTOs are beneficial to people with a mental illness. For example are the benefits of receiving enforced treatment outweighed by damage to the therapeutic relationship between the patient and the clinician. The view of most mental health practitioners is that despite the difficulties that arise in the management of CTOs, they are an example of how mental health law can be of therapeutic benefit to people with a mental illness. An alternative view and one expressed very strongly by consumer groups is that CTOs represent a human rights violation. People with a mental illness who are well enough to live in the community do not require such close and intimidating supervision. It interferes with people's right to choose their treatment, damages therapeutic relationships and diverts scarce community resources into legal rather than therapeutic services. This presentation, in considering the literature and consumer perspective, explores these two viewpoints. It considers whether changes to legislation and practice could result in improved community care while supporting people's human rights. Learning Objectives: 1.The audience will learn about the divergent views prevalent with regard to community treatment orders, a review of the research conducted as well as consumer and carer perspectives and ideas about how legislation may be improved to reduce possible human rights violations on people with a mental illness. 2.Mental health law is one of the most contentious issues in service delivery and it is clear that the use of CTOs and other types of compulsory community care will expand with the changes in the delivery of mental health care from an institutional to a community setting. It is an area of discussion, which is controversial and highlights the divisions between service providers and consumers. However it is also an area where with discussion and compromise some agreement can be reached as to how best to manage non-compliance in the community while maintaining a respect for the rights and dignity of people.