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Clinical stability in the community associated with long-term approved leave under the Mental Health Act 2001

Published online by Cambridge University Press:  19 May 2014

E. Bainbridge ,
F. Byrne ,
B. Hallahan  and
C. McDonald
E. Bainbridge*
Affiliation:
Department of Psychiatry, National University of Ireland Galway, Galway, Ireland West Galway Mental Health Services, Health Service Executive West, Galway, Ireland
F. Byrne
Affiliation:
Department of Psychiatry, National University of Ireland Galway, Galway, Ireland West Galway Mental Health Services, Health Service Executive West, Galway, Ireland
B. Hallahan
Affiliation:
Department of Psychiatry, National University of Ireland Galway, Galway, Ireland West Galway Mental Health Services, Health Service Executive West, Galway, Ireland
C. McDonald
Affiliation:
Department of Psychiatry, National University of Ireland Galway, Galway, Ireland West Galway Mental Health Services, Health Service Executive West, Galway, Ireland
*
*Address for correspondence: Dr E. Bainbridge, MRCPsych, Clinical Research Fellow, Department of Psychiatry, National University of Ireland Galway, Galway, Ireland. (Email: [email protected])
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Abstract

Introduction

We present the case of a 27-year-old man with a background diagnosis of treatment resistant schizophrenia and absent insight who for the last 3 years has been residing in a high support residential setting on approved leave under the Mental Health Act (MHA) 2001. The case demonstrates how this man achieved clinical stability in the community with the assistance of long-term involuntary admission under the MHA 2001, in contrast to the previous years of his illness in which he had suffered multiple relapses of his psychotic illness with ssociated distress, poor self-care and repeated in-patient re-admissions. We discuss the equivalent use of community treatment orders in other jurisdictions and how the judicious use of approved leave under the MHA 2001 may be used as an alternative in Ireland where community treatment orders are not currently available.

Method

Case Report.

Conclusion

The case report highlights how the use of long-term approved leave under the MHA2001 may be used as alternative in Ireland to mimic CTOs for certain difficult to treat patients with psychotic illness who would benefit from ongoing treatment, but lack capacity to engage in such treatment due to persistent symptoms and lack of insight.

Keywords

InvoluntaryMental Health Act 2001Schizophrenia
Type
Case Report
Information
Irish Journal of Psychological Medicine , Volume 31 , Issue 2 , June 2014 , pp. 143 - 148
Copyright
© College of Psychiatrists of Ireland 2014 

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References

Ajzenstadt, M, Aviram, U, Kalian, M, Kanter, A (2001). Involuntary outpatient commitment in Israel: treatment or control? International Journal of Law and Psychiatry 24, 637–657.Google Scholar
Burgess, P, Bindman, J, Leese, M, Henderson, C, Szmukler, G (2006). Do community treatment orders for mental illness reduce readmission to hospital? An epidemiological study. Social Psychiatry and Psychiatric Epidemiology 41, 574–579.Google Scholar
Burns, T, Rugkasa, J, Dawson, J, Yeeles, K, Vazquez-Montes, M, Sinclair, J, Priebe, S. (2013). Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial. The Lancet 381, 1627–1633.CrossRefGoogle ScholarPubMed
Cambell, J, Brophy, L, Healy, B, O’Brien, AM (2006). International perspectives on the use of community treatment orders: implications for mental health social workers. British Journal of Social Work 36, 1101–1118.Google Scholar
Eastman, N (1997). The Mental Health (patients in the community) Act 1995. A clinical analysis. British Journal of Psychiatry 170, 492–496.Google Scholar
Gibbs, A, Dawson, J, Ansley, C, Mullen, R (2005). How patients in New Zealand view community treatment orders. The Journal of Mental Health 14, 357–368.Google Scholar
Kisely, S, Campbell, LA, Scott, A, Preston, NJ, Xiao, J (2007). Randomized and non-randomized evidence for the effect of compulsory community and involuntary out-patient treatment on health service use: systematic review and meta-analysis. Psychological Medicine 37, 3–14.CrossRefGoogle ScholarPubMed
Kisely, SR, Campbell, LA, Preston, NJ (2011). Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews 16(2), CD004408.Google Scholar
Lally, J (2013). Liberty or dignity: community treatment orders and rights. Irish Journal of Psychological Medicine 30, 141–149.Google Scholar
Lawton-Smith, S (2005). A Question of Numbers: The Potential Impact of Community Based Treatment Orders in England and Wales. King’s Fund (http://www.kingsfund.org.uk/publications/question-numbers-community-based-treatment-orders-england-wales). Accessed 2 May 2014.Google Scholar
Lawton-Smith, S, Dawson, J, Burns, T (2008). Community treatment orders are not a good thing. British Journal of Psychiatry 193, 96–100.CrossRefGoogle Scholar
Manning, C, Molodynski, A, Rugkåsa, J, Dawson, J, Burns, T (2011). Community treatment orders in England and Wales: national survey of clinicians’ views and use. The Psychiatrist 35, 328–333.Google Scholar
Mental Health Act (2001). Mental Health Commision (http://www.mhcirl.ie/Mental_Health_Act_2001/Mental_Health_Act_2001.pdf). Accessed 10 October 2013.Google Scholar
Preston, NJ, Kisely, S, Xiao, J (2002). Assessing the outcome of compulsory psychiatric treatment in the community: epidemiological study in Western Australia. British Medical Journal 324, 1244.CrossRefGoogle ScholarPubMed
Romans, S, Dawson, J, Mullen, R, Gibbs, A (2004). How mental health clinicians view community treatment orders: a national New Zealand survey. Australian and New Zealand Journal of Psychiatry 38, 836–841.Google Scholar
Rugkåsa, J, Burns, T (2009). Community treatment orders. Psychiatry 8, 493–495.Google Scholar
Segal, SP, Burgess, PM (2006). Conditional release: a less restrictive alternative to hospitalization? Psychiatric Services 57, 1600–1606.Google Scholar
Sensky, T, Hughes, T, Hirsch, S (1991). Compulsory psychiatric treatment in the community. I. A controlled study of compulsory community treatment with extended leave under the Mental Health Act: special characteristics of patients treated and impact of treatment. British Journal of Psychiatry 158, 804.Google Scholar
Torrey, EF, Kaplan, RJ (1995). A national survey of the use of outpatient commitment. Psychiatric Services 46, 778–784.Google Scholar
Walsh, D (2010). Do we need community treatment orders in Ireland? Irish Journal of Psychological Medicine 27, 90–97.Google Scholar
Woolley, S (2010). Involuntary treatment in the community: role of community treatment orders. The Psychiatrist 34, 441–446.Google Scholar