Alberta's Community Treatment Order Legislation and Implementation: The First 18 Months in Review
Bibliographic record
Abstract
Introduction Providing the appropriate level of treatment and care to individuals with serious and persistent mental disorders can be a significant clinical challenge. Some individuals become caught in a revolving door cycle of formal hospitalization they meet the criteria for involuntary admission, respond to psychiatric treatment, and are discharged once stable, only to deteriorate in the community and require re-admission. Other individuals require long term hospitalization in psychiatric facilities as the nature of their symptoms and/or disabilities cannot be adequately and safely managed by resources available in the community on a completely voluntary basis. On January 1, 2010, Community Treatment Order (CTO) legislation was proclaimed for the first time in Alberta. (1) This provided an option for the community management of these This article provides information about the first 18 months of implementation of CTOs, based on the experience of Alberta clinicians and health care administrators, and the Mental Health Patient Advocate (Advocate). Brief background information will be reviewed and demographics of patients cared for under CTO legislation to date will be provided, as will a discussion of lessons learned and challenges to be resolved. Background Prior to the enactment of CTO legislation by way of Bill 31, the Mental Health Amendment Act, a substantial consultation process occurred. A legislative committee held public meetings, and submissions were heard from concerned individuals, as well as representatives from professional organizations, advocacy and consumer groups. During consultations on Bill 31, the Advocate was supportive of the introduction of CTOs, viewing them as a way to support recovery from mental illness. The Advocate's 2007 written submission on the Bill stated: There is an evolving recognition of the role that empowerment plays in mental illness and recovery. Experience from other jurisdictions shows that CTOs work best clients and substitute decision-makers are consulted and involved in the formulation of a CTO. (2) The Advocate submission also advised that appropriate checks and balances should be included in legislation to reduce the impact of CTOs on patients' rights under the Canadian Charter of Rights and Freedoms. Protections should include the right to independent review of the need for a CTO, the right to appeal unfavourable decisions to the courts, and to access legal counsel. Additionally, when they cannot afford legal counsel, legal aid should be provided. A standard practice for all patients placed on CTOS is a formal explanation of their rights. (3) The Advocate's support was also contingent on the appropriate supports being available to patients in the community. Recovery is limited unless the social determinants of health (e.g. treatment, housing, income, meaningiul activities) are addressed. Indeed the successful implementation of legislation that focxises on CTOs is predicated upon collaborative approaches to address these fundamental supports for patients. (4) Most of the Advocate's recommendations were accepted. Persons under CTO were accorded the same rights and protections as formal patients, including the right to access the Advocate. Legal Aid was provided at no cost regardless of income to those appealing their CTO to a Review Panel. Amendments to the Mental Health Act The amended Alberta Mental Health Act (the Act) sets out the criteria under which a CTO may be written. A CTO may be issued if two physicians, one of whom must be a psychiatrist, are of the opinion that the person is suffering from a mental disorder and that they meet applicable criteria to ensure that their psychiatric condition has proved to be chronic. Thus, the person must, in the preceding 3-year period, on 2 or more occasions for a total of at least 30 days, have been a formal patient in a facility, or have been lawfully detained in a custodial institution while meeting the criteria required to be a formal patient, or some combination of the two. …
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.037 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.011 | 0.016 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.007 | 0.002 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".