The community treatment order: clinical and ethical issues

Objective: In the light of recent legislation, this paper reviews the implementation of the Community Treatment Order (CTO) in terms of clinical efficacy and ethical issues involved in its use. The debate surrounding the introduction of CTOs in other countries is explored. Method: A Medline search was conducted and references of recent articles followed up, with attention to Australian, New Zealand and international trends. A review of relevant legislation and government reports was conducted. Results: There has been limited debate in the Australian and New Zealand literature concerning the operation of CTOs. Despite their increasing and widespread use, there is a paucity of research on the efficacy of CTOs. Concerns about their negative effects on civil liberties have been stressed in the United Kingdom and American literature. Conclusions: If the continued use of CTO is to be justified, both clinically and from the civil liberties perspective, controlled research needs to be carried out to identify whether CTOs are more effective than comprehensive assertive community outreach programs in reducing relapse rates and hospitalisation, and increasing compliance. Clinical guidelines concerning who is most likely to respond to such orders need to be developed. Alternatives to the CTO are explored, and future directions in research are outlined.