Do we need community treatment orders in Ireland?

Area of Science:

• Psychiatry
• Mental Health Law
• Health Services Research

Background:

• The
• revolving door
• phenomenon, characterized by frequent psychiatric readmissions (72% in Ireland), is a significant concern.
• Treatment non-adherence with aftercare is believed to contribute to these readmissions.
• Legislative measures like compulsory community treatment orders (CTOs) have been implemented in Scotland, England, and Wales to improve adherence and reduce readmissions.

Purpose of the Study:

• To evaluate the effectiveness of compulsory community treatment orders (CTOs) in enhancing treatment adherence and reducing psychiatric re-admissions.
• To determine if CTOs should be considered for introduction into Irish civil mental health legislation.

Main Methods:

• Review of legislative measures implemented in various countries to improve treatment adherence and reduce re-admissions.
• Examination of the existing evidence regarding the effectiveness of these measures, specifically CTOs.

Main Results:

• Evaluation of CTO effectiveness is constrained by limited data and confounding factors.
• The available evidence does not provide convincing proof of the utility of CTOs in reducing psychiatric readmissions or improving adherence.

Conclusions:

• Insufficient evidence exists to recommend the immediate introduction of CTOs in Ireland's civil mental health legislation.
• A
• wait and see
• policy is advised, alongside critical assessment of CTO implementation in Scotland and England/Wales.
• Further research into the characteristics of
• revolving door
• patients in Ireland and the determinants of their readmission is advocated. The Criminal Law (Insanity) Act 2006 in Ireland has an anomaly regarding conditional discharge enforcement.