Psychiatrists’ use of community treatment orders (or outpatient committal) in the UK is already ten times more frequent than was originally envisioned, writes Manchester Metropolitan University’s Ken McLaughlin in Politics.co.uk. This is evidence, he argues, that the whole idea of community treatment orders is misguided.
“(P)sychiatric practice is still all too often directed not by advances in mental health care but by the political and cultural concerns of the day,” writes McLaughlin. “The use and abuse of Community Treatment Orders (CTOs) is but one of the more recent manifestations of this process. They are reflective of a wider culture of fear and risk aversion, of a political establishment increasingly concerned with the micromanagement of community life, a process which also affects professionals who increasingly work in a risk-averse manner.”
“It was initially thought that CTOs would mainly be used on patients with several psychiatric admissions, the so-called ‘revolving door’ patient phenomenon, whereby someone was admitted to hospital, got better with medication, was discharged, stopped taking the medication, relapsed, was readmitted to hospital and so on. Irrespective of this, a history of non-compliance is not necessary for a CTO to be imposed; it can be applied to a patient after a first compulsory admission for treatment provided the necessary criteria are met.”
McLaughlin says that government envisaged 350-450 CTOs would be issued in England and Wales in the first year that the powers came in to force. “However, the number far exceeded the government’s and its advisers’ expectations. In the first five months in which professionals were able to issue them, November 2008 to March 2009, there were 2,134 issued in England alone.” In 2012, writes McLaughlin, there were 4,764 people subject to such orders – many following their first admission to a psychiatric hospital.
Community Treatment Orders: Politics and psychiatry in a culture of fear (Politics.co.uk, October 7, 2014)