Mental health

Mental health
Introduction

The issue of mental health is one that encompasses various spheres in life. It has an effect
on the decisions being made by the individual as well as the choice of life he decides to take. It is
therefore mostly looked at through the legal and medical lenses. When one is diagnosed with
mental illness, there are various issues that arise such as the capacity of that person to make
decisions for himself or for the others around him. This invites the legal interpretation to try and
help in the evaluation of their capacities to make decisions and specifically in terms of medical
assistance for their mental incapability. The treatment of people with mental health issues should
also be within the ethical and legal parameters. The introduction of the Community Treatment
Orders has been welcomed with both enthusiasm as well as disdain. This is because of the mixed
reaction that it receives from all quarters. This is because of the nonconsensual nature and mode
of treatment it allows the people with mental health issues to undergo. This is because in the
administration of the treatment without the consent of the patient, a violation of their
fundamental rights and freedoms is being perpetrated. This paper will look at the issues that have
arisen due to the Community Treatment Orders as well as the consequent legal and
repercussions.
The Community Treatment Orders and their effect
The Community Treatment Order is an order that permits medical personnel to
administer treatments without the consent of the patients to those with mental health problems

MENTAL HEALTH 2
while they are living with the rest of the community (Mental Health Act, 2009). It allows for the
compulsory outpatient treatment of people with mental issues. The main objective of the Act is
the provision of treatment and care of people with severe mental illness while observing their
fundamental rights and freedoms. This provision gives licensed medical practitioners the leeway
in administering treatment to those with mental health issues while still within their communal
settings (Light et al, 2012).
The diagnosis of mental health issues is in itself a challenge. This is because of the
various manifestations of the characteristics. The high prevalence of the mental health illness in
Australia, especially among the young population is alarming. A sizable number of the children
and youth in Australia have mental health problems. Approximately a quarter of this population
has access to health care that is suited for their specific needs (Sawyer et al, 2001). Such
staggering statistics and the future of the country were therefore at risk due to the mental health
problems ailing the nation. The use of the Community Treatment Orders on the youthful
population was also a way to ensure that they grow up in their communities for their chances at
normal life to be increased. This shows the importance of tackling the mental health problems in
a manner that is professional as well as pocket friendly. The Community Treatment Order was
for the reduction of these cases as the lack of individual care was highly unlikely. The design of
the mental health care system had to be revamped in order to adequately take care of the
increasing number of mental health patients (McGorry, Bates and Birchwood, 2013). In so doing
the accessibility of health care for those with severe mental problems and were unable to access
it for one reason or the other was statutorily provided for. This method was also meant to
decongest the mental hospitals as well as provide the said patients with an opportunity to
reintegrate back to the community. The Community Treatment order however comes with

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various conditions for the patient who risks readmission in to psychiatric facilities in case of non
compliance with the set rules. These are meant to reinforce the voluntariness of the patients into
cooperating with the medical practitioners (Owens and Brophy, 2013).
Despite the noble intention to ensure the provision of mental health care to those unable
to access it, there are various issues, legal, ethical, theoretical and policy related that have
emerged due to this mode of treatment and are yet to be addressed. This has been made worse by
the rise in the use of this method of treatment over the past few years. To begin with, the process
of the administration of the treatment had very little development. This is especially with regards
to the process of identification of the potential patients, the duration of the treatment and the
termination of the same (Vine et al, 2016). The lack of the due process to be followed in the
same has created a system that is susceptible to abuse by the health care practitioners mandated
to offer these treatment services. The vagaries of this wide berth of power have placed the mental
health sector in a state of limbo. This is because of the different processes of treatments that can
be administered hence lack of uniformity. The risk that the patients run in the quality of service
they receive is also high (Robertson et al, 2013). The risk that the community where the patient
resides is also high as there are times when the mental patient becomes violent or does something
that endangers their lives. The Community Treatment order is meant for those with severe
mental issues and as such the predictability of their behavioral characteristics is close to nil. It
therefore places the general public in danger should the patients lash out. This aspect of the
welfare of the rest of the community was overlooked in the best interest of a few. The
observance of the fundamental rights and freedoms of the rest of the population in terms of their
safety and peace of mind is thereby compromised. This is just one legal issue that faces the
Community Treatment Order. The improvement of the quality of service as well as the

MENTAL HEALTH 4
establishment of policies and mechanisms to hold and improve the accountability of the
Community Treatment order is prudent for these services to achieve their intended purpose. This
is in addition to resourcing the medical branch of community health (Light et al, 2017).
On the same issue of rights and freedoms, the compulsory treatment is a direct violation
of the rights of the mental patients. This is because they are free to decide what is good for them
as they see fit and this form of treatment it is a forceful process they have to undertake or risk
being admitted in a psychiatric facility (Owens and Brophy, 2013). How can one compel another
to voluntarily accept something or face consequences? The lack of consent in this case signifies
the deprivation of their free will. For treatments to work effectively, especially those that touch
on the mental aspect of life, the voluntariness of the person receiving treatment is vital and as a
result of the coerciveness of this treatment method, there have been various revocations within
months of the start of this treatment process. It therefore goes without say that the legal rights
due to the patients are denied thereby making the state guilty of violating the same rules they
vowed to uphold as well as their being discriminatory practices allowed by the state.
The practice by the licensed medical practitioners in compulsorily giving medical
attention is discriminatory to those with mental issues. This therefore makes it a human rights
issue as the deprivation of a select few group of people is on the line. The forcible treatment of
this mental illness constitutes the only way one is forced to undergo treatment. The other types of
illnesses, whether mental or physical, the state allows for the patient to seek the treatment option
he sees fit and gives them the option to choose whether to get treatment or not after diagnosis. In
examining some of the conditions that are categorized as mental illnesses, some of them are drug
related and hence one cannot force others to undergo treatment when they do not want to. This
discrimination on the basis of health and specifically the type of health problem one has needs to

MENTAL HEALTH 5
be addressed. It is only in the treatment of the mental cases as human rights issues that the
underlying disadvantages of the method that Community Treatment order methods can be
improved and adequate policy and legal considerations made for its subsequent improvement
(Obrien, 2014).
The chances of recurrence of the mental issues people are treated with using the
Community treatment Order raise the question as to the efficacy of this method. The discharge of
patients with mental health issues who have received treatment under the Community treatment
order is done by three major ways, by the review board, the person in charge of treatments and
the last method was by the expiry of the Community Treatment order. The discharge by the
treating psychiatrist was found to have less recurring cases of mental illnesses while the
remaining two experienced higher rates of recurrences. The study showed that the process that is
used to discharge the patients with mental health issues is flawed (Vine et al, 2016). This is
partly due to lack of legal or policy guidelines to the same and hence no blue print to fine tune
the procedures that have to be taken when dealing with patients under the Community treatment
Order. This causes the stigmatization of the people with the mental health issues. The lack of
clear guidelines is a recipe for lack of accountability and exposes them to abuse, both by their
caregivers and the community at large. The general guidelines that are in the Mental Health
Statement of Rights and Responsibilities is too general and majorly focuses on the call to the
general public to respect the mental health rights of others as well as their own. It does not
provide clear guidelines as to the way it can actually be done. This statement is pretty much an
exoskeleton of the rules as to the general treatment of the mental rights of others but is not that
helpful when it comes to the nitty gritty details of the same. It also does not tackle the specific
mental health problems.

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The mode of treatment for patients with mental health issues is pretty much standardized.
This means that their need to be a connection between the patient and the medical personnel in
charge. This creates an atmosphere of trust that hastens the recovery process. The constant
supervision and hence the presence of the medical practitioner is vital (The Australian Royal and
New Zealand College of Psychiatrists Clinical Practice Guidelines team for Depression, 2016).
However, in the administration of Community treatment Orders, the constant presence of the
medical personnel is close to impossible as they do not live together. This mode of treatment is
therefore not as effective as it ought to be. The treatment choice is one that has to be made by the
supervising medical personnel and this is usually after spending some time with the patient,
knows the patient in addition to understanding the cause of the problem. This is effectively done
in a controlled environment, free from external interferences. This also creates an environment of
trust between the two, an important component in the treatment of mental issues. However, in the
Community Treatment Order, the constant presence and supervision of the medical personnel is
lacking and hence the lack of trust. This eventually has a negative impact on the well being of
the mental patient. The lack of this close supervision has led to the overdose of the
antipsychotics. This is because these medicines are prescribed but due to lack of trained
personnel who understand their concentrated composition, the patients getting treatments at the
community level end up taking more than the required dosage or even less (Gisev, Bell and
Chen, 2014). This in turn creates more health problems that were originally not there, and hence
worsens the already bad situation.
The treatment of those with severe mental problems in the community has also been seen
to have more than one effect on the patients. This is due to the marginalization and
stigmatization they experience by being with those who can hardly understand them. This

MENTAL HEALTH 7
problem worsens their mental sanity as it ends up being stressful instead of providing fertile
grounds for recovery. Giving them treatment outside a controlled area exposes them to
vulnerabilities that lurk with their contact with people who do not understand their specific
special needs. This in turn compromises on the quality of treatment they receive (Light et al,
2014).
In a nutshell, the treatment of those with severe mental health problems in Australia has
had its fair share of ups and downs. The establishment of the Community Treatment orders was
meant to be a reprieve for these types of patients as the treatment seeks to help them reintegrate
back into the community and help them live in harmony with the rest of the population despite
their mental incapacitation to do so. There are many shortcomings to this treatment method that
make it ineffective (Burns et al, 2013). The reduction of the mental patients in enclosed
psychiatric facilities by the use of the Community Treatment Orders proved to have very little
effect on the mental health of the patients. This is partly due to lack of proper legal and policy
guidelines that govern the treatment method. The lack of supervision and monitoring of the
medical personnel as well as the vast freedom to operate in the delivery of the said services is
also a cause of concern. The lack of interest in mental health as well as methods of improving the
same has caused widespread stigmatization for those suffering from mental illnesses.
Mental health and sociology. There are various causes for mental health problems
around the world. These causes are however majorly determinant on the sociological integration
one is exposed to. The sociological factors are important in the creation of communal ties that
are said to act as cushions in the buffering of the effects that mental health problems have. They
help in improving the situation as well as act as support beams for the patients (World Health
Organisation, 2014). It is therefore prudent that in dealing with mental health problems a strong

MENTAL HEALTH 8
support group made up of family and friends are available to lend a supportive hand to the
patient. One of the reasons why the Community Treatment Orders are gaining popularity not
only in Australia but also around the world is the notion that the treatment for these severe health
issues can be best handled within a community setting. It is therefore important that the role of
sociology is understood in the treatment of mental illnesses as well as the amount of control in
place. The discussion on mental health issue has however not been met with the seriousness it
deserves, this is despite the rise in mental health issues (Sawyer et al, 2001).
The exposure of the patients to harmful societal characteristics such as violence and
crime during their treatment phases has had a negative effect on their health. This is because,
instead of encountering supportive community members, the contrary has led to worsening of the
situation (Rogers and Pilgrim, 2014). The determination of whether one is mentally ill should not
be predicated on a few symptoms they exhibit, according to Rogers and Pilgrim, the diagnosis on
the mental health of one should be based on a variety of factors. These factors should also be
borne in mind in the determination of the best treatment method to be administered. In the case
of Community Treatment Order, the severity of the condition should be looked at from the
perspective of the patient’s surroundings.
The role that the social surrounding plays in the success of the treatment program that
makes up the Community Treatment Order is vital in the final determination of the success of the
treatment. This is because of the surrounding that the particular patient needs in addition to the
support framework the patient will receive. However, there is neither policy nor legal indications
of the same.
Recommendations. The issue of mental health is a thorny one that has seen little
development if not none in some jurisdictions. The need to conduct extensive research to

MENTAL HEALTH 9
understand mental health issues is important (Light, 2014). This is because of a number of issues
that have not been understood as of yet about mental health issues. This has led to the
underdevelopment of the legal, policy and other regulatory mechanisms in the continuous use of
the method of treatment that is Community Treatment order. There are also various loopholes
that the Mental Health Act has left pending such as the severity of the mental illness to warrant
the order. There has also been little research as to the effectiveness of this method of treatment,
something that has led to doubts about it. The subsequent study to the effective methods that can
be used in the Community Treatment Order has not been adequately done (Morandi et al, 2017).
It is therefore prudent that more research is carried out to find out more about mental health and
in particular the methods of treatment for each and every mental problem. This is because of the
different causes and hence symptoms of mental health issues which require specialized treatment
that is to be administered in accordance with the respective symptoms. The uniqueness of every
case needs to be appreciated for the particular method of treatment to be effective. In effect, the
effectiveness of the Community treatment order needs to be audited as the rate of its efficiency to
be determined so that it can be improved or done away with. It is therefore my recommendation
that extensive research in to all aspects of mental health be done and the subsequent methods of
treatment. There should also be constant audits to find out the effectiveness of the methods after
a while to determine their viability with the continuous changes in the global lifestyle.
The voluntariness of the patient in the methods of treatment should not be dispensed with
as it is a key element in the efficacy of any treatment. In this case, the mental patients should be
allowed to have a say or at least be meant to believe that they have a say in the treatment
methods they undergo.

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Conclusion. The issue of mental health is one that is hardly ever touched on as it is
considered a taboo topic in many jurisdictions. The rise of mental health cases has led to the
Mental Health Act 1990 but since then there have been little development in the area of mental
health, either legally, policy wise or regulatory. This has created a wide berth of freedoms for
those who practice medicine in the area of mental health. There is little or no supervision in their
profession, which has exposed it to vagaries making it prone to abuse and misuse. The lack of
regulation has also made the processes involved in the administration of Community treatment
order to be exposed to personal prejudices, thereby making it inefficient. As a process that was
established to ensure maximum effectiveness in the treatment of mental health issues, the
Community Treatment order falls short of one of the most fundamental principles that underlie
its establishment, the protection of human rights. This is because in its application, the
voluntariness of the patient is dispensed with as it is a coercive method of treatment. This is one
of the demerits of this method as effective treatment usually requires the voluntary submission of
the patient. There are however ways to improve these methods which include the use of data
collected from extensive research on mental health issues and how to effectively deal with them.
The choice of the patients in choosing treatment methods should also be incorporated in the
various treatments.

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References

Australian, R., & New Zealand College of Psychiatrists Clinical Practice Guidelines Team for
Depression. (2016). Australian and New Zealand clinical practice guidelines for the
treatment of depression. Australian & New Zealand Journal of Psychiatry.
Burns, T., Rugkåsa, J., Molodynski, A., Dawson, J., Yeeles, K., Vazquez-Montes, M., … &
Priebe, S. (2013). Community treatment orders for patients with psychosis (OCTET): a
randomised controlled trial. The Lancet, 381(9878), 1627-1633.

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