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so, are others on a treatment order?

 

has anyone successfully fought one?

 

i'm so fucking angry about it. i did find this study showing that compulsory maintenance medication isn't more effective at reducing hospital re admission: http://www.ncbi.nlm.nih.gov/pubmed/23537605

 

but i also just feel so ...like...violated

 

and since i'm discredited i don't know if there's anything i can really do to successfully be considered a person again. ugh

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I am on a CTO and never bothered fighting it. The reason i never bothered was because I didn't really notice any effects, because their arn't any if you comply. You might feel it's taking away your freedom off choice when it comes down to taking your meds but chances are your mental health is sustained while taking them as prescibed, which is the goal of the CTO.

 

I made the mistake of reducing my meds without consent of the doctor as subsequently got ill. This happened twice before the doctor decided it was best to put me on a CTO to make sure I stay well. It's my fault i'm on a CTO so i feel like made by bed so i have to lie in it.

 

I read the study. Just would like to say i've been out of hospital for a year now so i think the CTO has benefitted me. :)

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I am on a CTO because i refused medication for my dis order and i was becoming paranoid and delusional in a manic state, the police and psych said enough was enough. I was constantly shaking people in town thought i was on drugs and i was becoming very violent and threatening towards myself and others and property

 

I have been on a CTO out of hospital almost 4 weeks now and i didn't bother fighting it, there is no point. Once you've been labbelled crazy people look at you in a different way regardless.

 

The thing is i have to do blood tests every few weeks to monitor epilim levels in my system and the thing i hate the most about a CTO is you have no management of your medication, what the PDOC says goes... regardless of side effects ect... if it works then that's what he does. I hate how many medications i am on but i'd raher be on a CTO out of hospital than been treated inside

 

I have rebounded a few times and the next time i was told was a needle....... so i'd rather just be compliant. I guess when the PDOC sees it fit that i can look after myself and manage my medication i will be taken off it

 

but for now it sucks. even if i have an episode on meds even if it is minor it all gets noted

 

The GP and PDOC both want me back in hospital during the transition period of changing medication wich really sucks! but they let me do it the easy way now

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It's never a pleasant thing to have the courts decide how much treatment is needed instead of an individual and their care team.

 

And it's unfortunate that community treatment orders have to exist.

 

But they are the counterbalance to people having NO process to challenge the loss of civil liberties and being held against their wishes at an inpatient setting for interminable amounts of time.

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I've been on treatment orders a lot of my life. Every time I got out of the state hospital it was "renewed" for several more years. Now just like 2 years ago when I finally got a new pdoc, I was allowed to let my treatment order expire. I haven't been on one since.

Though I'm not sure how much you'd consider my freedom because I have monitored meds still. I have to take them in front of a staff of the medical staff in the morning and am allowed to have my bedtime ones taken home. Then I take the morning meds again the next day in front of staff. A few years ago I wasn't even trusted with getting my bedtime meds. So I'd have to take the morning meds then again at bedtime take those in front of staff too.

And if I miss case management appointments or pdoc appointments I get the cops called for a welfare check.

Soooooo...still feels like a treatment order to me.

Ugh

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I think it is violating. I'm adamantly opposed to CTOs. There's no evidence they do any good (cite: http://summaries.cochrane.org/CD004408/compulsory-community-and-involuntary-outpatient-treatment-for-people-with-severe-mental-disorders. )....and if that's the case how can you possibly justify violating someone's civil liberties?

And my experience has been that the greatest help I've gotten from my providers has been through developing a trusting relationship over time. Even when I've been unable to think rationally, they've never violated that trust, and I have given them cause. There's no overestimating the value of that trust, and I wouldn't have been able to get the help I really needed without it.

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Assertive Community Treatment is a much, much better model than court ordered treatment.

 

I agree, kate... it's totally violating and makes it harder to have effective working relationships with providers.

 

But the question remains, what other options are there when someone is hell bent on destroying themselves, someone else, or is too gravely disabled to be safe in their own home? Do we, as a society, have some obligation to help that person access the treatment that will help them get better?

 

I'm not saying court ordered treatment is the best way to achieve that goal. However, in a culture that emphasizes individual liberty, there has to be a transparent process to remove some of those liberties.

 

Then again, MI is weird. It's the only medical condition for which you can be treated against your will (unless you have been found incompetent to make your own medical decisions... but the the treatment is usually for something else).

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yes, that's exactly my point kate; cheers

best wishes to you cheese i am sorry you understand all too well

probably given my history and so forth i have been advised that fighting it is grim at best

but having the support/understanding some who can appreciate how dehumanizing it is

(also very glad to hear others are feeling better i don't think they should be able to force me i am tired of this shit and it's practically putting me into overmuch really)

has made this worthwhile. cheers x

Edited by mellifluous
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Assertive Community Treatment is a much, much better model than court ordered treatment.

 

I agree, kate... it's totally violating and makes it harder to have effective working relationships with providers.

 

But the question remains, what other options are there when someone is hell bent on destroying themselves, someone else, or is too gravely disabled to be safe in their own home? Do we, as a society, have some obligation to help that person access the treatment that will help them get better?

 

I'm not saying court ordered treatment is the best way to achieve that goal. However, in a culture that emphasizes individual liberty, there has to be a transparent process to remove some of those liberties.

 

Then again, MI is weird. It's the only medical condition for which you can be treated against your will (unless you have been found incompetent to make your own medical decisions... but the the treatment is usually for something else).

There's a saying in medicine "don't just do something. Stand there." The idea is to resist the urge to do things that won't help, just because it seems like something has to be done. CTO's are exactly an example of that. they do a lot of harm, and there's no evidence they do any good.

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Lacking autonomy sucks ass. For sure.

 

But should I stand idly by and watch you destroy yourself or someone else when you have an illness that can be treated, but you are refusing the treatment BECAUSE of your illness?

 

What is the middle path?

 

It's not rhetorical.

 

It's unfortunately the case that some people are not capable of accessing treatment when they need it because of the illness.

 

Taking away someone's civil rights should NEVER be done lightly, without a transparent process, or in any way that is arbitrary.

 

I guess what I'm saying is that involuntary treatment is a sometimes necessary evil to prevent further harm due to someone's illness.

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CTOs have their issues, for sure. Telling someone they are incapable of making decisions for themselves is dehumanising. However, I agree with Wooster in that there's a fine line between letting someone harm themselves [and possibly others] vs helping them.

 

The problem with mental illness is its pervasive nature. The impact on cognition can be such that the individual may not be aware they are neglecting themselves to the point of endangering their physical health. Or it can cause harm to those around them as well. If the altered state of cognition is your reality, then you're not going to be readily aware that something is not optimal for your health and safety. 

 

I see a parallel between CTOs and dementia in the elderly. When my grandmother was in the early throes of dementia, she insisted nothing was wrong and that she was not going into a nursing home. Yet she got lost often [one time for over 12 hours and somehow breaking her collarbone], she wasn't feeding herself properly and she almost started a fire in her apartment. In the end, my family could not respect her wishes not to enter a nursing home and to live by herself, because we could plainly see she was going to hurt herself more. She wasn't aware she was harming herself - her cognition was altered to the extent where she couldn't understand. 

 

To me, the problem with CTOs is not so much their application, but how they are implemented. Too often, people are placed onto a CTO, told to go <x> place for their medication / pdoc meetings etc., but there is less emphasis on therapeutic support. People should be given the necessary skills to prevent a relapse [hence preventing the occurrence of more CTOs] but I've noticed many programs tend to emphasise a medical model. The message is to take <x> med, be compliant and eventually get off the CTO - but without the necessary coping skills, medication can only do so much. 

 

Mental illness is a complicated condition. There's both emotional and medical facets to consider, but from what I've seen from CTOs, there's not enough recognition of the emotional needs of the person. 

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My question, though, is how do you prevent the harm that is otherwise already happening?

Maybe you can't do anything. But again, implementing a CTO just because you feel like you should do something is bad medicine. Because it looks like it does more harm than good.

Personally, I would focus on what reverse is talking about -if someone doesn't want Meds, then focus on social and emotional support, and access to services.

Melli- I'm really sorry you're going through this, and I'm also surprised. It always sounded from your posts like you had good insight into your illness, and weren't resisting treatment - what happened?

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Personally, I would focus on what reverse is talking about -if someone doesn't want Meds, then focus on social and emotional support, and access to services.

 

 

Yes, absolutely. In no way do I want you to think that I think involuntary treatments should only be about meds and hospitals. However, if someone is not able to participate in consensual reality safely without meds, that's a problem.

 

People should ALWAYS have the least restrictive means of treatment available... that usually means community care instead of institutional care, and social and emotional support.

 

I also wanted to respond more fully to mell's first point about 

 

 

and since i'm discredited i don't know if there's anything i can really do to successfully be considered a person again. 

This is a rough thing. Unfortunately it takes time and skills, and often med compliance. It's totally true that once you've been on an involuntary treatment order it's more likely that you will have additional risk of future involuntary treatment orders.

 

It's a shitty deal. And unfortunately it's the best we have in an imperfect system right now.

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Kate, I have to say I disagree with this:

 

 

 But again, implementing a CTO just because you feel like you should do something is bad medicine. 

 

It's not about FEELING like one should do something. It's about preventing loss of life or permanent damage due to impaired ability to keep oneself safe. It's about PREVENTING FURTHER HARM based on the harm that is ALREADY happening.

 

 

 

Also just going to throw this out there...

 

 

 

Implementation of a CTO was associated with an increase in engagement, a decrease in the number of admissions, and increased time spent outside hospital... This small localised study indicates that supervised community treatment can have benefits for some patients. The challenge now is to examine the practice of supervised community treatment and to receive meaningful feedback from people who are subject to such treatment.

 

--http://pb.rcpsych.org/content/36/8/298.abstract

 

 

I think one could argue that SOME community treatment orders do help SOME people SOME of the time. They are NEVER ideal.

 

 

Do I think that involuntary treatment is beneficial? In limited cases, yes.

Do I think that involuntary treatment focuses too much on medication adherence and not enough on social and emotional supports? absolutely

Do I think we can do better? absolutely

 

I suspect we may have to agree to disagree about whether involuntary treatment is necessary at times.

 

 

ETA: Something we haven't even talked about yet are mental health advanced directives. I think these go a long way in helping express preferences and maintaining as much autonomy as possible in situations where it is not possible to consent to needed care.

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you damn right it's not rhetorical. this is my fucking life not some hypothetical debate

nobody is asking you or anyone else to sit idly by and watch anything

for the record i neither have now act on homicidal orders or thoughts

and, yes, kate, i am just brimming with insight

and let me tell you: the more insight the better is bullshit because having it certainly isn't making my life better

and really my point her, wooster, is that my life should be mine to determine and not others' and no other illness gets you compulsory treatment or all of these bullshit involuntary commissions either. i spend literally thousands of days of my life in the fucking hospital, taken tons of meds over the years, it's enough. enough enough enough. i am tired of being forced to live everyone else's life when where's the fucking justice! people get to eat and drink and go around doing what they want so long as it doesn't directly injure others but they can eat fast food and not properly treat coronary disease but that's because they've not been discredited by the model that determines i no longer get to be a person. nothing new given this has been happening for twenty years but those fuckers can't keep me forever and they can all have done to them what they're doing to me so far as i care anymore.

and i do have an advance directive--in response to your last note there

Edited by mellifluous
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I agree with you, mell, that your life should be yours to determine and that there is no other illness that has court ordered treatment.

 

Maybe you missed the parts where I said those things.

 

In any case, I am sorry that it sucks and there's nothing to be done but go along with the plan. You have every right to be pissed. 

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I dont understand how they can justify locking people up from the public behind bars in what they call a hospital... LAst time i checked a hospital didn't have prison bars and barbed wire fences and double locked doors

 

It's a bloody disgrace because you basically get forced onto meds without a choice and side effects pffft not their problem

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