![]() ![]() We propose a five-step framework for determining the ethical status of offers by mental health professionals and give detailed guidance for professionals about how to exercise leverage.Ĭommunity Treatment Orders do not deliver clinical or social functioning benefits for patients. Professionals were committed to patient-centred approaches, but felt obliged to assert authority when patients relapsed. Patients’ experiences of pressure were wide-ranging and pervasive, and perceived to come from family, friends and themselves, as well as professionals. Reporting leverage made little difference to patients’ perceived coercion. ![]() ![]() One-third (35%) of the ULTIMA sample reported lifetime experiences of leverage, lower than in the USA (51%), but patterns of leverage experience were similar. Patients with longer CTO duration spent fewer nights in hospital. ![]() There was no difference in readmission outcomes over 36 months. Longer duration of compulsion was associated with longer time to disengagement ( p = 0.023) and fewer periods of discontinuity ( p < 0.001). At 36-month follow-up, only 19 patients (6% of 329 patients) were no longer in regular contact with services. No general ethical justification was found for the use of a CTO regime. Qualitative work suggested that CTOs’ (perceived) focus on medication adherence may influence how they are experienced. There was no evidence that it might be cost-effective. There were no differences for any subgroups. For the follow-up study, the primary outcome was the level of disengagement during the 36 months.Ĭommunity treatment order use did not reduce the rate of readmission or any other outcome. Other outcomes included measures of hospitalisation, a range of clinical and social measures, and a newly developed measure of capabilities – the Oxford Capabilities Questionnaire – Mental Health. The OCTET Trial primary outcome was psychiatric readmission. Participants in the ULTIMA Study were 417 patients from Assertive Outreach Teams, Community Mental Health Teams and substance misuse services. Participants in the OCTET Study were 336 patients with psychosis diagnoses, currently admitted involuntarily and considered for ongoing community treatment under supervision. The programme comprised three studies, with associated substudies: Oxford Community Treatment Order Evaluation Trial (OCTET) – a study of CTOs comprising a randomised controlled trial comparing treatment on CTO to voluntary treatment via Section 17 Leave (leave of absence during treatment under section of the MHA), with 12-month follow-up, an economic evaluation, a qualitative study, an ethical analysis, the development of a new measure of capabilities and a detailed legal analysis of the trial design OCTET Follow-up Study – a follow-up at 36 months and Use of Leverage Tools to Improve Adherence in community Mental Health care (ULTIMA) – a study of informal coercion comprising a quantitative cross-sectional study of leverage, a qualitative study of patient and professional perceptions, and an ethical analysis. Little is known about the nature and operation of informal coercion. Community compulsion was introduced in England and Wales as community treatment orders (CTOs) in 2008, despite equivocal evidence of effectiveness. Coercion comprises formal coercion or compulsion and informal coercion (a range of treatment pressures, including leverage). ![]()
0 Comments
Leave a Reply. |