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
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Kisely S, Campbell LA. Community treatment orders for psychiatric patients: the emperor with no clothes. Can J Psychiatry 2006; 51: 683-688.
- 2. Lawton-Smith S. A question of numbers. The potential impact of community-based treatment orders in England and Wales. London: King's Fund, 2005.
- 3. McSherry, B. Protecting the integrity of the person: developing limitations on involuntary treatment. In: McSherry B, editor. International trends in mental health laws. Sydney: The Federation Press, 2008.
- 4. Kisely SR, Campbell LA, Preston NJ. Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane Database Syst Rev 2011; (2): CD004408. DOI: 10.1002/14651858.CD004408.pub3.
- 5. Xiao J, Preston NJ, Kisely S. What determines compulsory community treatment? A logistic regression analysis using linked mental health and offender databases. Aust N Z J Psychiatry 2004; 38: 613-618.
- 6. Link BG, Epperson MW, Perron BE, et al. Arrest outcomes associated with outpatient commitment in New York State. Psychiatr Serv 2011; 62: 504-508.
- 7. Kisely S, Campbell LA, Scott A, et al. Randomized and non-randomized evidence for the effect of compulsory community and involuntary out-patient treatment on health service use: systematic review and meta-analysis. Psychol Med 2007; 37: 3-14.
- 8. Swartz MS, Swanson JW, Hiday VA, et al. A randomized controlled trial of outpatient commitment in North Carolina. Psychiatr Serv 2001; 52: 325-329.
- 9. Steadman HJ, Gounis K, Dennis D, et al. Assessing the New York involuntary outpatient commitment pilot program. Psychiatr Serv 2001; 52: 330-336.
- 10. Burns T, Rugkåsa J, Molodynski A, et al. Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial. Lancet 2013; 381: 1627-1633.
- 11. Kisely S, Preston N, Xiao J, et al. Reducing all-cause mortality among patients with psychiatric disorders: a population-based study. CMAJ 2013; 185: E50-E56.
No relevant disclosures.