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Community treatment orders turn caring into authority


Excessive use of community treatment orders has changed how patients view community psychiatric nurses, the Care Quality Commission has said.

CTOs are used to force mental health patients to take their medication when being cared for in the community.

In a report last week, the CQC found the number of CTOs being applied had risen 10 fold since their introduction in November 2008 to an average 367 a month.

The inspectorate found that, in a sample of CTO patients, 30 per cent had no history of refusing to take medication or of not cooperating with community services.

The finding suggests that, in contrast to original intentions to use the orders only when patients are at risk of not complying with their medication, in about one third of cases they were being used as a precautionary or preventative measure.

As a patient’s compliance with a CTO is often monitored by a community psychiatric nurse, the CQC said the orders had changed the way patients perceived their nurses, as well as how nurses perceived themselves – turning them into a more authoritarian than caring figure.

The report’s main author policy analyst Mat Kinton told Nursing Times that in some cases CTOs bred “complacency” as mental health trusts felt that, as long as a patient was being forced to take their medication, their duty of care was at an end.

“The very worst ones we have seen are where people come into a clinic once a month to pick up their pills or get a jab and that is the entire extent of the engagement with them,” he said.

The report also found black and minority ethnic patients were being disproportionately subjected to CTOs – a finding Mr Kinton described as “very worrying”.

“We are concerned that there are more patients from some of the BME groups placed on a CTO, ” he said.


Readers' comments (5)

  • This clarifies that the NHS is racist as we all know but pretend not to. The racism does not only extend to patients but also to uncountable ethnic minority staff members who suffer in silence. This happens because staff are not supported by their Trust HR who boast falsely of practicing equality in their so-called policies but turn a blind eye to racism, inequality, bullying and harassment. Several Trusts have Foundation rating without having been researched properly for fairness and equality before they are granted the title. Healthcare is a caring profession but is it really experienced as such by staff and patients, or are we simply deluded in such outrageous belief?

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  • A very interesting statement to make about the health service. I believe it is not just the NHS, but it is society as a whole. The NHS is one segment within loads of other parts that make healthcare and other public services. Policies and procedures are in place to protect people and ensure that their rights are upheld. However in the grand scheme of things nurses and other healthcare professionals seem to sometimes lack common sense. If people do wish to stop taking medication, there are other interventions which they may find useful. Also I believe that people's views surrounding mental illness and the need for medication need to change. A lot has been done to carry this out, however often enough there is inadequate support for CPNs from LHAs and other government authorities.

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  • it should be more widely accepted by healthcare professionals that all medication and drugs have serious side effects (even the herbal and some homeopathic varieties) and the precise effects are often unknown, especially psychiatric drugs and their effects on the brain, not to mention the bad press the pharmaceutical industry has had recently. therefore no patient should ever be forced to take medication, except under exceptional circumstances, and only then under the supervision of a fully qualified psychiatrist. too many harmful drugs are being dished out currently by nurses, gps and junior doctors without fully understanding the risks. the final decision should rest with the patient alone and only then when he is in possession of the full facts about the medication concerned with all the risks and potential benefits involved. this goes for other treatments as well which should only be administered with the patient's consent. The European regulations have to be complied for care of patients with mental health disorders a care in the rest of Western Europe is of a far higher standard and more advanced than in the UK and delivered by highly qualified professionals where the patients needs and wishes are central and taken into account,

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  • My understanding of CTO's is, that if a patient became non-concordant with their medication and treatment whilst in the community they could be forced to return to hospital for assesment and possible treatment but could not be forced to take medication whilst in the community.

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  • CTOs should only be used in extreme circumstances in the best interests of the patients, and not the staff looking after them. They should only be given by qualified medical practitioners and only after thorough examination. It is against human rights to force somebody to take medication or force a hospitalisation unless they are in servere danger to themselves or the public when the MH Act can come into force. If too many unqualified people are involved in CTOs it can lead to abuse of the patient's rights and their own best interests.

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