Revocation of Community Treatment Orders in a mental health service network

Abstract

Community Treatment Orders (CTOs) require patients to co-operate with involuntary treatment in the community or risk having their CTO revoked and being readmitted to hospital. CTOs are used frequently in Australia. Their revocation has been under-investigated but is important because of the significant impact this process has on patients, families/carers and service-providers. This paper reports on an investigation of CTO revocations in a Victorian area mental health service in the period 2008-2010. This was a mixed-methods study involving extraction of data from the Victorian statewide clinical database, a file audit and semi-structured group interviews with key stakeholders. Two different time periods were compared. CTOs are commonly revoked within three months of discharge from the inpatient unit and multiple service-providers and family/carers have varying involvement that appears to depend on the timing of the referral to the Crisis Assessment and Treatment Team. The study identified opportunities for improving policy and practice, particularly in relation to reducing the amount of coercion experienced by people on CTOs and improving flexibility of service delivery.