Objective: The aim of this paper is to explore the relationship between civil commitment under a Community Treatment Order (CTO) and competence to consent to treatment.
Method: A purposive convenience sample of 10 service users under CTOs were interviewed using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Ratings were compared with the ratings of 10 matched voluntary service users.
Results: Seventy percent of the CTO sample were found to be incompetent according to the MacCAT-T, compared to 20% of the comparison group (p = 0.004). The proportion of the CTO sample found to be incompetent reduces to 50% if the subscale of appreciation is excluded (p = 0.004). Most people in each group would elect to continue their current treatment if given the choice.
Conclusion: Findings of this study suggest that mental health law reform introducing considerations of competence could lead to a substantially different group of people being subject to CTOs. If the CTO is carefully targeted and not used excessively, it is likely to be accorded qualified acceptance for most service users for whom it is used.
Lawton-SmithSDawsonJBurnsT. Community treatment orders are not a good thing. The British Journal of Psychiatry2008; 193: 96–100.
2.
DawsonJSzmuklerG. Fusion of mental health and incapacity legislation. British Journal of Psychiatry2006; 188: 504–509.
3.
OkaiDOwenGMcGuireHSinghSChurchillRHotopfM. Mental capacity in psychiatric patients: Systematic review. British Journal of Psychiatry2007; 191: 291–297.
4.
Ministry of Health, Office of the Director of Mental Health. Annual Report 2006. Wellington: Ministry of Health; 2007.
5.
AppelbaumPSGrissoT. The MacArthur Treatment Competence Study. I: Mental illness and competence to consent to treatment. Law & Human Behavior1995; 19: 105–126.
6.
GrissoTAppelbaumPSMulveyEPFletcherK. The MacArthur Treatment Competence Study. II: Measures of abilities related to competence to consent to treatment. Law & Human Behavior1995; 19: 127–148.
7.
GrissoTAppelbaumPS. The MacArthur Treatment Competence Study. III: Abilities of patients to consent to psychiatric and medical treatments. Law & Human Behavior1995; 19: 149–174.
8.
AppelbaumPS. Decisional capacity of patients with schizophrenia to consent to research: taking stock. Schizophrenia Bulletin2006; 32: 22–25.
9.
CarpenterWTGoldJMLahtiAC. Decisional capacity for informed consent in schizophrenia research. Archives of General Psychiatry2000; 57: 533–538.
10.
GrissoTAppelbaumPSHill-FotouhiC. The MacCAT-T: a clinical tool to assess patients’ capacities to make treatment decisions. Psychiatric Services1997; 48: 1415–1419.
11.
WingJKBeevorASCurtisRHParkSBHaddenSBurnsA. Health of the Nation Outcome Scales (HoNOS). Research and development. British Journal of Psychiatry1998; 172: 11–18.
12.
GrissoTAppelbaumP. Assessing Competence to Consent to Treatment: a Guide for Physicians and Other Health Professionals. Oxford University Press, New York1998.
13.
DawsonJMullenR. Insight and use of community treatment orders. Journal of Mental Health2008; 17: 269–280.
14.
Lawton-SmithS. Community-based Compulsory Treatment Orders in Scotland. The Early Evidence. King's Fund, London2006.
15.
GibbsADawsonJAnsleyCMullenR. How patients in New Zealand view community treatment orders. Journal of Mental Health2005; 14: 357–368.
16.
BartlettP. The test of compulsion in mental health law: capacity, therapeutic benefit and dangerousness as possible criteria. Medical Law Review2003; 11: 326–352.
17.
BellSABrookbanksE. Mental Health Law in New Zealand2nd edn. Brookers, Wellington2005.
18.
AppelbaumPS. Almost a revolution: an international perspective on the law of involuntary commitment. Journal of the American Academy of Psychiatry & the Law1997; 25: 135–147.
19.
HidayVA. Outpatient commitment: the state of empirical research on its outcomes. Psychology, Public Policy, & Law2003; 9: 8–32.
20.
DawsonJRomansSGibbsARatterN. Ambivalence about community treatment orders. International Journal of Law and Psychiatry2003; 26: 243–255.
21.
SegalSPTauberAI. Revisiting Hume's Law. American Journal of Bioethics2007; 7: 43–44.
22.
SchneiderPLBramstedtKA. When psychiatry and bioethics disagree about patient decision-making capacity (DMC). Journal of Medical Ethics2006; 32: 90–93.
