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Reappraising community treatment orders — can there be consensus?

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Community treatment orders have become standard practice without serious consideration of the underlying research base

Community treatment orders (CTOs) require someone with a mental illness to follow a treatment plan while living in the community.1 Initially, debate focused on the ethical justification for CTOs, but subsequently shifted to their effectiveness. These considerations are particularly relevant to Australia as a few states, such as Victoria, have among the highest rates of CTO use in the world.2 Further, CTOs may also be incompatible with Australia’s obligations to the United Nations Convention on the Rights of Persons with Disabilities.3 Here, we present a consensus from two authors who have previously expressed very different views on the use of CTOs.1

We note, at the outset, a lack of clarity about the purpose, or purposes, of CTOs. Are they to reduce revolving-door admissions, provide a less restrictive alternative to involuntary admission, prevent violence by people with severe mental illness, or increase stability and promote recovery? These different aims involve a range of different outcomes: hospital use, perceived coercion, violent acts and quality of life. Uncertainty about their purpose is compounded by the range of different interventions. Interventions include clinician-initiated…