Do Community Treatment Orders violate human rights?

Researchers from New Zealand and Australia have claimed that a standard practice used in psychiatry may be ineffective and violate international human rights conventions.

Community Treatment Orders (CTOs) enable psychiatrists to force people with serious mental health symptoms to have treatment without consent. In New Zealand, a CTO may be imposed even if the person who is refusing treatment is competent. That is, even if they understand and can weigh up its benefits and risks.

Dr Giles Newton-Howes from the Psychological Medicine Department of the University of Otago, Wellington, and Associate Professor Christopher Ryan from the University of Sydney have recently published an editorial in the British Journal of Clinical Psychiatry arguing that CTOs should not be used for competent patients.

“We believe that using CTOs to force treatment on people who competently refuse it is a violation of the international conventions that our countries have signed up to and that the process is out of step with other health practices,” says lead author Dr Newton-Howes.

“Moreover, it may be they do more harm than good. Forcing a competent person to have psychiatric treatment that they have decided they don’t want is like putting a smoker into hospital because they won’t give up,” he says.

“Randomised controlled trials are usually regarded as the gold standard of whether or not a medical intervention is effective. There have been so far been three randomised controlled trials on CTOs. None showed any efficacy.

“In other types of studies that have sometimes demonstrated benefit, it appears that the benefit comes when people are able to get more help. This suggests that it’s the health service provided, not the CTO, that makes the difference.

“We need better funded and more integrated services, not the capacity to breach people’s human rights to enforce treatment,” says Dr Newton-Howes.

Link to full editorial: http://bjp.rcpsych.org/content/210/5/311

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