Dr Russ Scott1
1West Moreton Mental Health Service, Brisbane, Australia, 2West Moreton Mental Health Service, Brisbane, Australia
Biography:
As the first forensic psychiatrist accredited by the RANZCP, Russ Scott has been a consultant psychiatrist to community forensic outreach services and acute inpatient units at the Thomas Embling Hospital, Melbourne and the High Security Inpatient Services at The Park – Centre for Mental Health, Wacol. He is a past president of the Medico-Legal Society of Queensland and ANZAPPL (Qld). In 2023 he was appointed Clinical Associate Professor, School of Medicine, University of Queensland and he is the medical issues section sub-editor of the Journal of Law and Medicine. He is currently employed by the West Moreton mental health service.
Abstract:
The ‘recovery model’ in mental health recognises the ‘dignity of risk’ and a patient’s ‘right to failure.’ Advocates of ‘rights-based’ mental health legislation agitate to limit restrictive practices including use of community treatment orders (CTOs). The term “efficacy” refers to how well a treatment or intervention appears to work in an ideal, controlled setting whilst the term “effectiveness” refers to how well a treatment or intervention works in ‘real-world’ practice. The 2017 Cochrane review of involuntary outpatient treatment which only considered, as the primary outcome, re-admission to hospital, has significant limitations in external validity. A recent umbrella review of systematic reviews and meta-analyses intended to assess the possible harms of CTOs included studies limited to the 12 months following CTO placement. The observational studies were likely subject to recording bias and many of the constituent meta-analyses results had high heterogeneity and low numbers of contributing studies which limited the assessment of publication bias. Study heterogeneity also prevented the meta-analysis of results from different systematic reviews and there were also overlapping findings of the same outcomes. The most significant limitation of the umbrella review was the exclusion of any studies of involuntary treatment in forensic contexts such that those ‘high risk’ patients who were the most likely to benefit from a CTO were not included in the review. There is an expanding body of research demonstrating the ‘real world’ effectiveness of CTOs as a less restrictive alternative to involuntary hospitalization in providing the treatment needs of patients with chronic mental illness.