Community treatment orders and competence to consent

Area of Science:

• Psychiatry
• Mental Health Law
• Clinical Psychology

Background:

• Community Treatment Orders (CTOs) are a legal mechanism for involuntary psychiatric treatment in the community.
• Assessing patient competence to consent to treatment is crucial for ethical and legal practice.

Purpose of the Study:

• To investigate the relationship between civil commitment under CTOs and a patient's competence to consent to treatment.
• To compare the competence of individuals on CTOs with voluntary patients.

Main Methods:

• A purposive sample of 10 service users under CTOs were assessed using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T).
• Competence ratings were compared to those of 10 matched voluntary service users.

Main Results:

• Seventy percent of the CTO sample were rated as incompetent to consent to treatment, significantly higher than the 20% in the voluntary group (p = 0.004).
• Excluding the 'appreciation' subscale reduced CTO incompetence to 50% (p = 0.004).
• A majority in both groups preferred to continue their current treatment if given a choice.

Conclusions:

• Mental health law reform incorporating competence assessments could alter the population subject to CTOs.
• Targeted and judicious use of CTOs may achieve qualified acceptance among service users.