Shrunk wrote:Scarlett wrote:Personally I don't agree it should be a criminal offence for you not to take your meds, let's face it, not all schizophrenics will become killers or even dangerous in any way.
It's not a topic I know a lot about. How do you ensure someone continues to take meds? Can they be found more culpable if they have chosen not to take meds that were proven to work? Surely not taking the meds could be a symptom of the illness?
The way the CTO law is written is quite clever: The order is incorporated as part of the treatment contract, and must be consented to by the patient. If the patient is not mentally capable of providing consent then, as in any other such situation, someone else consents on his behalf. So it's not a matter of making non-adherence a criminal offence. Enforcement of adherence becomes an aspect of treatment that has been consented to.
It is also only applicable if someone has a demonstrated history of deterioration severe enough to require hospitalization when not treatment, and of documented response to treatment. The goal is not necessarily to protect the public from the patient, but to allow the patient to remain out of hospital.
With injectable medication, it's easy to tell if it is being taken. It's a bit more difficult with pills, but not impossible (blood levels can be measured, or medications can be taken under observation at home or by coming in to the clinic daily.)
Schizophrenics relate/respond to their illness in different ways and at different times. Insight into their disease may be irratic indeed, or absent altogether, yet CYO's in Australia do not seem to be designed to acknowledge these simple facts. That is, medication must be administered for prolonged periods of time to improve quality of life, a reduction in psychotic episodes, the emergence of insight, and so on.
In my experience as a carer, the sufferer barely had time to recover before a CTO expired. It was pot-luck if the holy grail of insight appears. if it does, then of course the CTO can be lifted because the patient concerned realised the value of the medication. If insight did not recur, then the patient was deemed of sound mind, and discharged from the CTO, soon after which she stopped taking the medication.
There is also the question of this roller-coaster of meds-non-meds being of long term harm. After a crash the meds were usually of high dosage, and of course in non-insight period, no meds were taken at all. [We did find out that the meds given were often the highest doage in the state, calibrated for body mass.
While not wishing to return to the old horrors of life-time retention of mental patients, the revolving door system of CTO's does not seem to address concerns about the support of the chronically and severly ill. Their "legal rights" do not give them freedom from their disease, or necessarily an improved quality of life.