CRITICAL PSYCHIATRY NETWORK STATEMENT ON THE USE OF COMMUNITY TREATMENT ORDERS
The following comments summarise a discussion that took place at a Critical Psychiatry Network meeting on 19 September 2007.
There was general concern about the ethics of using Community Treatment Orders. People present felt that if people were functioning well enough to be living in the community, and had capacity to decide about their treatment, that it was unethical to apply the Mental Health Act to force them to take treatment in the community. There were also ethical concerns about practicalities of forcing someone to take treatment in this situation. The use of force to remove someone from their home, take them to a "clinical setting" and force them to take medication seemed unacceptable, and would exacerbate stigma.
It was strongly felt that the use of Community Treatment Orders might frighten people away from psychiatric services. There were concerns about how they would be implemented in practical terms and about how it would be possible for anyone to ever get off a Community Treatment Order, in view of the fact they would have to prove a negative, that is they would not get ill in the future. There were also concerns that other members of staff could initiate the Community Treatment Order proposal without the Consultant Psychiatrist being in agreement that this was necessary. This would lead to conflict within the treatment team. It was also felt that the requirement that anyone who is sent on Section 17 MHA leave for more than 7 days should have a Community Treatment Order considered, could unnecessarily increase the use of Community Treatment Orders and make it more difficult to use Section 17 MHA leave.
There were also concerns that the availability of a Community Section would lead to significantly increased numbers of patients being detained under the Mental Health Act. This means that an increased proportion of psychiatric service users would have their autonomy curtailed and their Human Rights infringed. Finally, there were also strong concerns that the use of such legislation would exacerbate the mental health inequalities experienced by people from Black and Minority Ethnic Communities, especially African-Caribbean people, who, historically, have been much more likely to experience coercion in mental health services.