Community Treatment Orders in Australia in the Context of International Literature: A Narrative Review of Consumers, Families and Health Professionals' Perspectives

Abstract

A community treatment order (CTO) sets out legal conditions requiring a person experiencing mental illness to receive treatment and medication while living in the community. Although CTOs are used internationally in most high-income nations, CTO use in Australia is very high compared with world standards. CTOs are a contentious issue in mental health practice. While they aim to protect both consumers and society, they often interfere with personal freedom and trust between consumers and mental health professionals. International and Australian research is inconclusive about the effectiveness of CTOs in achieving their clinical aims. Australian research overwhelmingly reports consumers' experience with CTOs as coercive and distressing. Families generally support CTOs but are unhappy with certain aspects of the process. Consumers and families' feelings about CTOs often depend on how much they trust the mental health team, the support they receive, and the relationship between the consumer and mental health professional. Health professionals experience significant challenges balancing therapeutic care with their role carrying out CTOs. Local treatment culture, problems in the mental health system and staff attitudes also influence how CTOs are used. There is a lack of recent and high-quality guidance to inform CTO decision-making for mental health professionals. This perspective paper is presented as a narrative literature review, which proposes that if CTOs are used in clinical practice, close consideration towards how and why they are implemented is warranted.