Abstract
Controversy around the use of community treatment orders (CTOs) arises in part from their ambiguous evidence base. Recent research has provided valuable new insights into the effects of CTOs, while also highlighting the critical importance of first understanding what CTOs are and what they are meant to achieve. A genuine public discourse on the significance of CTOs will have multiple perspectives. This necessitates a more pluralistic approach to constructing the necessary knowledge of CTOs to enable communities to make sound decisions about their use.
Highlights
Debates about ethical and human rights issues relating to community treatment orders (CTOs) span all jurisdictions, whether CTOs are a recent development or more established
These debates concern the principle of using coercion in clinical practice, the impact of CTOs on the autonomy and privacy interests of individuals, and the provision of appropriate mental healthcare that is not reliant on unnecessary compulsion to compensate for under-resourced community services.[3,4,5,6]
The Oxford Community Treatment Order Evaluation Trial’s (OCTET’s) finding that CTOs did not reduce rates of hospital readmissions compared with existing provisions in England and Wales for supervised hospital leave[13] is among a number of recent research outcomes providing valuable new insights into the effects of CTOs
Summary
Despite the controversies surrounding their efficacy, the utilisation of community treatment orders (CTOs) is increasing worldwide.[1,2] Debates about ethical and human rights issues relating to CTOs span all jurisdictions, whether CTOs are a recent development (as in the 2007 Mental Health Act provisions in England and Wales) or more established (as in the provisions first introduced in the Australian state of New South Wales in 1990) These debates concern the principle of using coercion in clinical practice, the impact of CTOs on the autonomy and privacy interests of individuals, and the provision of appropriate mental healthcare that is not reliant on unnecessary compulsion to compensate for under-resourced community services.[3,4,5,6] Such issues are common to all jurisdictions, despite the variations in legislative provisions for CTO systems, which include differences in the criteria for applying CTOs and the powers given to healthcare providers. It is important to take proper account of the data that do exist
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