THE S U N D A Y AGE

JANUARY 6

'Lazy' psychiatrists blamed for high medication r

somebody, listening to them," said Isabell Collins, director of the Victorian Mental lUness Awareness Cotmcil. "When you have the capacity to impose your will on another person it is an ethical dilemma. You should sit down with your colleagues or with the patient to work out ways that you can ensure that somebody's safe but also at the sametimeprotect their rights. There is this tmconscious attitude that they've got a mental illness so we can treat them differently to people with general health problems." However, David Castle, head of psychiatry at St Vincent's Hospital, said it was too simplistic to conclude from the data that Victoria's high rates of community treatment orders (CTOs) Communily treatment orders Rate per 100.000 2010/U 2005 NSW 46.4 37.4 VIC 98.8 55 OLD 613 N/A TAS 302 N/A WA 48.6 17.6 Source Australasian Psychiatry meant there was a problem with the system. "Victoria has better developed community care than most jurisdictions but we also have fewer beds and a lot of bed pressures. So we get people out of inpatient facilities into the commimity and, to ensure they get the care that they need, including medication, that's when CTOs tend to be used," Professor Castle said. "The spirit of it should be they're used for ongoing comprehensive care for people who have a stiong likelihood and history of relapse and may be ariskto self or others. But there's no doubt that sometimes they can be used quite threateningly. We should use them with a different dialogue and as part of a much more inclusive package of care." The study's lead author, Edwina Light, a doctoral candidatefromthe Centre for Values, Ethics and the Law in Medicine at the University of Sydney, said littie research had been done on the effectiveness of CTOs and what had been done was contradictory, making it hard to conclude whether or not CTOs were effective. She said it was unclear why they were increasingly being used in Australia but it could be due to underresourcing of the mental health and criminal justice systems, differences in the way legislation was applied in each state, and varying attitudes of clinicians. "We hope that in the course of governments reviewing thefr legislation they might look at this research and explore how they can better monitor and report on mentalhealth services, and fiirther examine how and why community freatment orders are used," Ms Light said.

medication-in 2010-11, compared with 46 in New South Wales and 99 in iacrORIA has the highest rate in Victoria. The Victorian rate has \ustralia of involuntary psychiatric jiunped from 55 per 100,000 when a treatment orders, prompting claims similar study was conducted in 2005. lazy" doctors are unnecessarily Some psychiatrists argue the orders medicating patients. are a vital therapeutic tool, which can A study published in Australasian keep those who are so ill they may be a Psychiatry found that by world risk to themselves or others, out of standards, rates of community hospital. But mental-health advocates treatment orders are high and say they are unnecessarily coercive increasing in Australia, but Victorian and there is not enough evidence they :linicians are using them at up to triple result in better care for patients. the rate of other stales. "These rates are high because of In Tasmania, 30 people per 100,000 the laziness of psychiatrists. It's much population were subjected to the easier for them to put someone on a arders - which enforce outpatient community treatment order and to treatment for a set period of time, and force them onto medication than it is aften involve injections of long-acting to negotiate and spend time with

IILL STARK

A spokesman for Department of Healt Victoria pioneered tl community treatmei people receive treatri envirormient rather 1 setting, their use in tl under greater scrutir Victorian governmer introduce a new mei The new act will incl independent tribune determine whether ( tieatment orders she review existing ordei The new act aims length of compulsor ensure it is carried oi restrictive and intrus