Community treatment orders and antipsychotic long-acting injections.

BACKGROUND: The community treatment order (CTO) is the legal framework by which people in the community are compelled to accept treatment. Both antipsychotic long-acting injections (LAIs) and CTOs are used to address treatment non-adherence. AIMS: To investigate the relationship between CTOs and LAI use in patients with schizophrenia. METHOD: Prescribing, demographic and CTO data were collected for patients from four community mental health clinics in Melbourne, Australia, in 1998 and 2002. RESULTS: Against a background of increasing use of oral second-generation antipsychotic (SGA) medication and decreasing use of LAIs, the rates of CTO implementation doubled from 13% to 26% of patients with schizophrenia between 1998 and 2002. Proportionally more patients with a CTO are prescribed LAIs rather than oral SGAs. CONCLUSIONS: The relationship between receiving an LAI and being subject to a CTO is significant, and reflects the consideration given to enhancing adherence in a community mental health setting.

Why are community psychiatry services in Australia doing it so hard?

Since the National Mental Health Policy was implemented in 1992, dissonance between mental health professionals and the general public on the success of the deinstitutionalization components of the strategy has grown. Many of the premises on which the deinstitutionalization components were based are false, and this has led to many problems in the system. Community psychiatry is not fundamentally flawed, and what has been learned in the past 15 years can be used to build on the foundations that have been laid. Better cooperation between state and federal governments is needed to effect real change.

George Engel: a personal reminiscence.

OBJECTIVE: To provide a review of my personal exposure to the Medical Psychiatric (Medical Psy) Liaison Group in Rochester during the tenure of a National Health of Medical Research Council Travelling Fellowship in the Clinical Sciences from June 1975 to March 1977. METHOD: A personal reminiscence and review of a number of papers by George Engel. RESULTS: The Medical Psy Liaison Group had been developed by George Engel in 1946. My experiences were coloured by the fact that Engel had recently stepped down as Head and tensions in the structure and function of the group were obvious. CONCLUSION: My personal experience with Engel, the Medical Psy Liaison Group, Rochester psychiatry and my exposure to American psychiatry all had major influences on my subsequent career but perhaps not in a way that I might have expected when I went to Rochester.