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Forced Outpatient Psychiatric Treatment Provides No Benefits

cpuusage

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Forced Outpatient Psychiatric Treatment Provides No Benefits | Mad In America

November 28, 2014

Forced psychiatric treatment under Community Treatment Orders (CTOs), also referred to as forced or assisted outpatient treatment, provides “no clinical advantage” to patients on any measures of any kind, according to a meta-analysis of the scientific literature published in Social Psychiatry and Psychiatric Epidemiology. “If clinicians are to take a strictly evidence-based approach, then they cannot continue to use CTOs in their current form,” wrote the team of researchers from the UK, Norway and New Zealand.

“Community Treatment Orders require outpatients to adhere to treatment and permit rapid hospitalisation when necessary,” explained the researchers. “They have become a clinical and policy solution to repeated hospital readmissions despite some strong opposition and the contested nature of published evidence.”

The researchers reviewed all of the studies of every kind done on CTOs around the world, as well as other systemic reviews that have been done, with sample sizes ranging from 50 to 128,427. They placed particular emphasis on studies published since 2006 when the last major systematic review was done.

The researchers noted that qualitative studies have found that “clinicians prefer to work in systems where CTOs are available, that views among psychiatrists often get more positive over time, and that many believe CTOs to have positive clinical outcomes.” They also found that “family members find CTOs necessary or helpful but consider the community services offered to be inadequate,” while “patients reportedly hold ambivalent views, some finding aspects of the order helpful, while also restricting their lives in ways experienced as problematic.” All three groups felt the main objective of CTOs was to reduce hospital readmissions.

The researchers found, though, that the non-randomised outcome studies showed “conflicting results,” with some showing decreases and others showing increases in hospital admissions. One of the confounders frequently seen in these studies was that different types of community support services, such as those provided through assertive community treatment programs, were often provided in conjunction with the CTOs. “In contrast,” they wrote, “all three randomised controlled trials conducted concur in their findings that CTOs do not impact on hospital outcomes.”

One of the RCTs also showed that patients on CTOs ended up being forcibly treated for far longer than the control group. The researchers commented that this “raises the ethical question whether such a significant imposition on personal liberty can be justified in the absence of significant clinical benefits.”

“CTOs do neither appear to reduce relapse and readmission nor, overall, to reduce coercion,” concluded the researchers. “If clinicians are to take a strictly evidence-based approach, then they cannot continue to use CTOs in their current form.”

In their discussion, the researchers argued that “the lack of evidence for patient benefit, particularly when combined with restrictions to personal liberty, is striking and needs to be taken seriously. Clinicians have a duty to provide their patients with treatment in the least restrictive environment. The paucity of rigorous experimental research evidence for such an invasive intervention that has been in use for over three decades is quite remarkable. It raises a question of whether this would have been accepted in other branches of medicine. Surely major, intrusive interventions in community psychiatry should be expected to conform to the highest standards of evidence.”

(Abstract) CTOs: what is the state of the evidence? (Rugkåsa, Jorun et al. Social Psychiatry and Psychiatric Epidemiology. December 2014, Volume 49, Issue 12, pp 1861-1871. DOI: 10.1007/s00127-014-0839-7)
 
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supergreysmoke

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Plays into the stereotype & public folkmyth of mental illness. The violent patient who needs restraint by meds and burly types. People love a simplistic narrative explanation and one size fits all.
 
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firemonkee57

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It all comes down to what you do for those who are a danger to themselves or others, but who refuse treatment of any kind because they don't see they have a problem? Is it right just to leave them to their own devices?
Is the harm greater from doing something or from doing nothing?
 
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supergreysmoke

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It all comes down to what you do for those who are a danger to themselves or others, but who refuse treatment of any kind because they don't see they have a problem? Is it right just to leave them to their own devices?
Is the harm greater from doing something or from doing nothing?
Interventions should be targeted and nuanced. Maybe they are here? America as a long history of missing the target and making things worse in many spheres...a flaw in their national character?
 
BillFish

BillFish

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I dunno maybe patients need to be given leeway to hurt a damage their own lives and not micro managed so much. For those that don't have a history of violence against others and haven't inferred or suggested they would in psychiatric interviews, maybe they should be allowed to self destruct, with drugs alcohol and unhealthy poverty laden environments. Who are we to say that the state should baby sit them 24/7 ?
 

cpuusage

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It all comes down to what you do for those who are a danger to themselves or others, but who refuse treatment of any kind because they don't see they have a problem? Is it right just to leave them to their own devices?
Is the harm greater from doing something or from doing nothing?
You always say this. Who are these people? Have you got any examples?
 
BillFish

BillFish

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I think psychiatry is the only branch of medicine that uses sanctions to gain compliance isn't it? You can refuse treatment as an adult everywhere else in the NHS system? At what point do you say, ok, we've tried, you are on your own mate.Perhaps someone who's read a few mad in America blog posts, stopped taking his meds several times, had advice he can titrate his meds down from some anonymous forum experts etc?

Why not let them do their own thing? Seriously, why try to baby sit them? When the conditions get worse in his state provided flat and he stops paying the rent and gets evicted, let him go live in a hostel, his choice.
Why should the state impose a decent standard of living on him?
 

cpuusage

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I think psychiatry is the only branch of medicine that uses sanctions to gain compliance isn't it? You can refuse treatment as an adult everywhere else in the NHS system? At what point do you say, ok, we've tried, you are on your own mate.Perhaps someone who's read a few mad in America blog posts, stopped taking his meds several times, had advice he can titrate his meds down from some anonymous forum experts etc?

Why not let them do their own thing? Seriously, why try to baby sit them? When the conditions get worse in his state provided flat and he stops paying the rent and gets evicted, let him go live in a hostel, his choice.
Why should the state impose a decent standard of living on him?
The question is what are the best approaches for people - we don't all want life long compliance to biomedical psychiatry & drug regimes, or nothing. Especially when there is ample evidence of the effectiveness of more comprehensive psychological/social approaches. If i had a choice from the beginning of zero psychiatric treatment/interventions, or what i've had - then i'd likely choose the former. You & others can love your labels, psychiatric drugs, forced treatment, & hooey brain disease theory - some of us think it's all bullshit.

There is also the question of humanity & humane treatment. What your saying is like why should we help cancer victims, or out of work single mothers? Why help anyone for that matter? Lets just have no rules/laws & no humanity - we can go back to the 1400's, or introduce zero rights & a global totalitarian state.

i think it's unreasonable to put people through the potential horrors of the current mental health/psychiatric system, often fucking people up, & then just cut them loose. i think the system has an accountability for what it does to people. Not that it takes any responsibility anyway - the reality is often that many people are cut loose with zero support.

Should your blessed circumstances ever change for the worse Bill, i'd like to see what you think of everything then?
 
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supergreysmoke

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I've known a handful of 'dangerous types' who probably need a little bit extra input over twenty or thirty years being a service user. Not enough for the degree of hysteria and focus on the issue. Enough to have some systems in place, as a last resort.
 
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TheRedStar

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There is also the question of humanity & humane treatment. What your saying is like why should we help cancer victims, or out of work single mothers? Why help anyone for that matter? Lets just have no rules/laws & no humanity - we can go back to the 1400's, or introduce zero rights & a global totalitarian state.
Oh, cpu... it's not about treating people inhumanely - it's about giving them the gift of self-responsibility! I mean, just today I walked past several homeless people in a town where, before this year, I had never once seen someone sleeping on the streets... they looked truly grateful to be enjoying such self-empowerment, and appeared to be positively thriving as a result of the wonderful blessing that has been bestowed upon them...

I get the impression that what you described in the paragraph I've quoted is precisely the social reality that many right-wing types here and in the USA would like to force upon us all (ah, the irony of imposed 'freedom'...), and indeed are currently attempting to slowly enact through cuts deemed 'necessary' by - oh so conveniently - themselves, and others who stand to gain most from being left alone by the evil nanny state. It seems to me that such a way of life would represent a highly unpleasant combination of social anarchy and an economic plutocratic hegemony, but in a wonderful act of turd-polishing it is laughably presented as 'libertarianism' by those who espouse it.

Personally, I think more people should be introduced to Karl Polanyi's concept that some forms of freedom are actually bad.
 
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cpuusage

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I get the impression that what you described in the paragraph I've quoted is precisely the social reality that many right-wing types here and in the USA would like to force upon us all

Personally, I think more people should be introduced to Karl Polanyi's concept that some forms of freedom are actually bad.
Unfortunately both the left & the right appear to very much feed each other in relation to mental health issues.

All politics is largely bullshit imo. i can't agree with the current mental health system, & i don't entirely agree with liberalism.

My view, & always has been, is primarily for comprehensive psychosocial support.

i'm not entirely opposed to the Government, pharmacology, psychiatry or the mental health system - i think it's all in need of very major reform, but i don't see the answers coming from the political, economic & exoteric religious systems - they are the problem. i think things can be done a lot better, & there are the maps & models to do it - & there always has been.

i think we are in some kind of a transition, & there has been & will be casualties, probably a lot of them by the end of it all.

i'd see it that some Global systems are far fairer, better & more humane, in many areas - & it's either a case of using those systems, or not.

To my understanding there are best approaches to the area of mental health - That would improve the lives of everyone if used. The problem is the majority won't /can't see it/don't want it, & will fight to defend the current system - so we have what we have & continue in the ways that we are. Maybe humanity needs a Global nightmare scenario to truly wake up?

Regardless of all of it - Not a lot i can really do, & it isn't my personal responsibility, i'm just one individual posting my opinion on a mental health forum.
 

cpuusage

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It all comes down to what you do for those who are a danger to themselves or others, but who refuse treatment of any kind because they don't see they have a problem? Is it right just to leave them to their own devices?
Is the harm greater from doing something or from doing nothing?
Was considering this - Your questions are answered in the article/OP & research findings.
 
Dreambuggie

Dreambuggie

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Wish I could join in - but can't

Long story

Have a good brain session

I can't communicate online - Sad but true

Money - crap and tech
 
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