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Patient attitudes towards compulsory community treatment orders and advance directives

Published online by Cambridge University Press:  13 June 2014

Brian O'Donoghue ,
John Lyne ,
Michele Hill ,
Linda O'Rourke ,
Sally Daly  and
Larkin Feeney
Brian O'Donoghue*
Affiliation:
DETECT-Early Intervention Service for Psychosis, Avila House, Block 5, Blackrock Business Park, Carysfort Ave, Blackrock, Co Dublin, Ireland
John Lyne
Affiliation:
DETECT-Early Intervention Service for Psychosis, Avila House, Block 5, Blackrock Business Park, Carysfort Ave, Blackrock, Co Dublin, Ireland
Michele Hill
Affiliation:
Cluain Mhuire Mental Health Services
Linda O'Rourke
Affiliation:
St John of God/St Vincents University Hospital Postgraduate Training Scheme in Psychiatry, Liaison Psychiatry, Cluain Mhuire Mental Health Services, Newtownpark Ave, Blackrock, Co Dublin, Ireland
Sally Daly
Affiliation:
St John of God/St Vincents University Hospital Postgraduate Training Scheme in Psychiatry, Psychiatry for Later Life, St Vincents University Hospital, Elm Park, Dublin 4, Ireland
Larkin Feeney
Affiliation:
Cluain Mhuire Mental Health Services, Newtownpark Ave, Blackrock, Co Dublin, Royal College of Surgeons, Ireland
*
*Correspondence Email: [email protected]
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Abstract

Objectives: The Mental Health Act 2001 was implemented in Ireland in 2006, however, within this new legislation there is no provision for compulsory community treatment or advance directives, which are now established practice in other countries. We aimed to determine the proportion of patients who believe that compulsory treatment may be justified, the preference for where the treatment should be delivered and factors which may influence this preference. We also sought to determine the proportion of people who would be interested in the option of having an advance directive in their future care plan.

Methods: Patients who had been admitted involuntarily in a 183 bedded psychiatric hospital in Dublin (St John of God Hospital) over a 15 month period were interviewed one year following discharge. A structured interview was used and included the Birchwood Insight Scale and Drug Attitude Inventory (DAI).

Results: Sixty-seven patients were interviewed, which resulted in a follow-up rate of 68%. A total of 56% of participants believe that there are situations in which involuntary treatment with medication may be justified. Of the participants 59% think that the person should be admitted to hospital if they are going to be administered medication without consent. A total of 41 % of participants stated they would have preferred to have been treated at home rather than hospital and this was associated with having a diagnosis of an affective disorder or it being their first involuntary admission. Of the participants 84% expressed interest in having the option of an advance directive in their treatment care plan.

Conclusions: With the increasing community based provision of mental health services in Ireland a debate on compulsory community treatment orders and advance directives needs to take place amongst all stakeholders.

Keywords

Compulsory community treatmentMental Health ActInvoluntary admissionCoercionAdvance directive
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 27 , Issue 2 , June 2010 , pp. 66 - 71
Copyright
Copyright © Cambridge University Press 2010

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References

1.Pinfold, V, Bindman, J. Is compulsory community treatment ever justified? Psychiat Bull 2001; 25(7): 268–70.CrossRefGoogle Scholar
2.Department of Health [Ireland]. Mental Treatment Act 1945. 2008. Ref Type: StatuteGoogle Scholar
3.Kisely, S, Smith, M, Preston, NJ, Xiao, J. A comparison of health service use in two jurisdictions with and without compulsory community treatment. Psychol Med 2005 Sep; 35(9): 1357–67CrossRefGoogle ScholarPubMed
4.Skuse, D. Compulsory treatment in the community: concept and controversy. Int Psychiat 2009; 6(3): 54–5.CrossRefGoogle ScholarPubMed
5.Government of Ireland. A Vision for Change. 2006.Google Scholar
6.Srebnik, DS, La, Fond JQ. Advance directives for mental health treatment. Psychiat Serv 1999; 50(7): 919–25.CrossRefGoogle ScholarPubMed
7.World Health Organisation. International Classification of Diseases 10th Edition (ICD-10). 1992.Google Scholar
8.O'Donoghue, B, Lyne, J, Hill, M, Larkin, C, Feeney, L, O'Callaghan, E. Involuntary admission from the patients' perspective. Soc Psychiatry Psychiatric Epidemiol 2009 Aug 11, DOI:10.1007/S00127-009-0104-7Google Scholar
9.Crawford, MJ, Gibbon, R, Ellis, E, Waters, H. In hospital, at home, or not at all: A crosssectional survey of patient preferences for receipt of compulsory treatment. Psychiat Bull 2004; 28(10): 360–3.CrossRefGoogle Scholar
10.Birchwood, M, Smith, J, Drury, V, Healy, J, Macmillan, F, Slade, M. A self-report Insight Scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatr Scand 1994; 89(1): 62–7.CrossRefGoogle ScholarPubMed
11.Hogan, TP, Awad, AG, Eastwood, R. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med 1983; 13(1): 177–83.CrossRefGoogle ScholarPubMed
12.Papageorgiou, A, King, M, Janmohamed, A, Davidson, O, Dawson, J. Advance directives for patients compulsorily admitted to hospital with serious mental illness. Randomised controlled trial. Br J Psychiatry 2002; 181: 513–9.CrossRefGoogle ScholarPubMed
13.Mental Health Commission. Rules governing the use of seclusion and mechanical means of bodily restraint. 2006. Available at www.mhcirl.ieGoogle Scholar
14.Dawson, J. Community treatment orders in New Zealand. Int Psychiatry 2009; 6(3): 59–61.CrossRefGoogle ScholarPubMed
15.Priebe, S, Katsakou, C, Amos, Tet al.Patients' views and readmissions one year after involuntary hospitalisation. Br J Psychiatry 2009; 194(1): 49–54.CrossRefGoogle Scholar
16.Kisely, S, Campbell, LA, Preston, N. Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane Database Syst Rev 2005; (3): CD004408.CrossRefGoogle Scholar
17.Swartz, MS, Swanson, JW, Wagner, HR, Burns, BJ, Hiday, VA, Borum, R. Can involuntary outpatient commitment reduce hospital recidivism?: Findings from a randomized trial with severely mentally ill individuals. Am J Psychiatry 1999; 156(12): 1968–75.CrossRefGoogle ScholarPubMed
18.Preston, NJ, Kisely, S, Xiao, J. Assessing the outcome of compulsory psychiatric treatment in the community: epidemiological study in Western Australia. BMJ 2002; 324(7348): 1244.CrossRefGoogle ScholarPubMed
19.Burgess, P, Bindman, J, Leese, M, Henderson, C, Szmukler, G. Do community treatment orders for mental illness reduce readmission to hospital? An epidemiological study. Soc Psychiatry Psychiatric Epidemiol 2006; 41(7): 574–9.CrossRefGoogle ScholarPubMed
20.Kisely, SR, Xiao, J, Preston, NJ. Impact of compulsory community treatment on admission rates: survival analysis using linked mental health and offender databases. Br J Psychiatry 2004; 184: 432–8.CrossRefGoogle ScholarPubMed
21.Segal, SP, Preston, N, Kisely, S, Xiao, J. Conditional release in Western Australia: effect on hospital length of stay. Psychiat Serv 2009; 60(1): 94–9.CrossRefGoogle ScholarPubMed
22.Segal, SP, Burgess, PM. Conditional release: a less restrictive alternative to hospitalization? Psychiat Serv 2006; 57(11): 1600–6.CrossRefGoogle ScholarPubMed
23.Swartz, MS, Swanson, JW, Wagner, HR, Hannon, MJ, Burns, BJ, Shumway, M. Assessment of four stakeholder groups' preferences concerning outpatient commitment for persons with schizophrenia. Am J Psychiatry 2003; 160(6): 1139–46.CrossRefGoogle ScholarPubMed
24.Canvin, K, Bartlett, A, Pinfold, V. A“bittersweet pill to swallow”: learning from mental health service users' responses to compulsory community care in England. Health Soc Care Community 2002; 10(5): 361–9.CrossRefGoogle ScholarPubMed
25.Campbell, LA, Kisely, SR. Advance treatment directives for people with severe mental illness. Cochrane Database Syst Rev 2009; (1): CD005963.Google Scholar
26.Irish Council of Bioethics. Is it Time for Advance Healthcare Directives? Opinion. 2007.Google Scholar
27.Citizens Information Board. Advance Care Directives. 2009. Available at www.citizensinformationboard.ieGoogle Scholar
28.Medical Council of Ireland. Advance Directives – Discussion Document. 2009. Available at www.medicalcouncil.ieGoogle Scholar
29.Owen, GS, David, AS, Hayward, P, Richardson, G, Szmukler, G, Hotopf, M. Retrospective views of psychiatric in-patients regaining mental capacity. Br J Psychiat 2009; 195(5): 403–7.CrossRefGoogle ScholarPubMed