How shortcomings in the mental health system affect the use of involuntary community treatment orders

Light, EM; Robertson, MD; Boyce, P; Carney, T; Rosen, A; Cleary, M; Hunt, GE; O'Connor, N; Ryan, CJ; Kerridge, IH

How shortcomings in the mental health system affect the use of involuntary community treatment orders

Light, EM Robertson, MD Boyce, P Carney, T

Rosen, A Cleary, M

Hunt, GE O'Connor, N Ryan, CJ Kerridge, IH

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Publication Type:: Journal Article
Citation:: Australian Health Review, 2017, 41 (3), pp. 351 - 356
Issue Date:: 2017-01-01

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Field	Value	Language
dc.contributor.author	Light, EM	en_US
dc.contributor.author	Robertson, MD	en_US
dc.contributor.author	Boyce, P	en_US
dc.contributor.author	Carney, T https://orcid.org/0000-0002-3612-5986	en_US
dc.contributor.author	Rosen, A	en_US
dc.contributor.author	Cleary, M https://orcid.org/0000-0002-1453-4850	en_US
dc.contributor.author	Hunt, GE	en_US
dc.contributor.author	O'Connor, N	en_US
dc.contributor.author	Ryan, CJ	en_US
dc.contributor.author	Kerridge, IH	en_US
dc.date.available	2016-06-03	en_US
dc.date.issued	2017-01-01	en_US
dc.identifier.citation	Australian Health Review, 2017, 41 (3), pp. 351 - 356	en_US
dc.identifier.issn	0156-5788	en_US
dc.identifier.uri	http://hdl.handle.net/10453/123306
dc.description.abstract	© AHHA 2017. Objective The aim of the present study was to examine stakeholder perspectives on how the operation of the mental health system affects the use of involuntary community treatment orders (CTOs). Methods A qualitative study was performed, consisting of semi-structured interviews about CTO experiences with 38 purposively selected participants in New South Wales (NSW), Australia. Participants included mental health consumers (n≤5), carers (n≤6), clinicians (n≤15) and members of the Mental Health Review Tribunal of NSW (n≤12). Data were analysed using established qualitative methodologies. Results Analysis of participant accounts about CTOs and their role within the mental health system identified two key themes, namely that: (1) CTOs are used to increase access to services; and (2) CTOs cannot remedy non-existent or inadequate services. Conclusion The findings of the present study indicate that deficiencies in health service structures and resourcing are a significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntary and involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulating CTO implementation. What is known about this topic? Following the deinstitutionalisation of psychiatric services over recent decades, community settings are increasingly the focus for the delivery of mental health services to people living with severe and persistent mental illnesses. The rates of use of involuntary treatment in Australian community settings (under CTOs) vary between state and territory jurisdictions and are high by world standards; however, the reasons for variation in rates of CTO use are not well understood. What does this paper add? This paper provides an empirical basis for a link between the politics of mental health and the uptake and usefulness of CTOs. What are the implications for practitioners? This paper makes explicit the real-world demands on the mental health system and how service deficiencies are a significant determinant in the use of CTOs. Practitioners and policy makers need to be candid about system limitations and how they factor in clinical and legal justifications for using involuntary treatment. The results of the present study provide data to support advocacy to improve policy accountability and resourcing of community mental health services.	en_US
dc.relation.ispartof	Australian Health Review	en_US
dc.relation.isbasedon	10.1071/AH16074	en_US
dc.subject.classification	Health Policy & Services	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Mental Disorders	en_US
dc.subject.mesh	Community Mental Health Services	en_US
dc.subject.mesh	Qualitative Research	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Health Services Accessibility	en_US
dc.subject.mesh	New South Wales	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Interviews as Topic	en_US
dc.subject.mesh	Involuntary Treatment	en_US
dc.title	How shortcomings in the mental health system affect the use of involuntary community treatment orders	en_US
dc.type	Journal Article
utslib.citation.volume	3	en_US
utslib.citation.volume	41	en_US
utslib.for	1801 Law	en_US
utslib.for	1110 Nursing	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Law
utslib.copyright.status	closed_access
pubs.issue	3	en_US
pubs.publication-status	Published	en_US
pubs.volume	41	en_US

Abstract:

© AHHA 2017. Objective The aim of the present study was to examine stakeholder perspectives on how the operation of the mental health system affects the use of involuntary community treatment orders (CTOs). Methods A qualitative study was performed, consisting of semi-structured interviews about CTO experiences with 38 purposively selected participants in New South Wales (NSW), Australia. Participants included mental health consumers (n≤5), carers (n≤6), clinicians (n≤15) and members of the Mental Health Review Tribunal of NSW (n≤12). Data were analysed using established qualitative methodologies. Results Analysis of participant accounts about CTOs and their role within the mental health system identified two key themes, namely that: (1) CTOs are used to increase access to services; and (2) CTOs cannot remedy non-existent or inadequate services. Conclusion The findings of the present study indicate that deficiencies in health service structures and resourcing are a significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntary and involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulating CTO implementation. What is known about this topic? Following the deinstitutionalisation of psychiatric services over recent decades, community settings are increasingly the focus for the delivery of mental health services to people living with severe and persistent mental illnesses. The rates of use of involuntary treatment in Australian community settings (under CTOs) vary between state and territory jurisdictions and are high by world standards; however, the reasons for variation in rates of CTO use are not well understood. What does this paper add? This paper provides an empirical basis for a link between the politics of mental health and the uptake and usefulness of CTOs. What are the implications for practitioners? This paper makes explicit the real-world demands on the mental health system and how service deficiencies are a significant determinant in the use of CTOs. Practitioners and policy makers need to be candid about system limitations and how they factor in clinical and legal justifications for using involuntary treatment. The results of the present study provide data to support advocacy to improve policy accountability and resourcing of community mental health services.

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http://hdl.handle.net/10453/123306