Authors: Lisa Brophy, Tessa-May Zirnsak, Vrinda Edan, Paul Armitage, Steve Kisely, Sharon Lawn, Chris Maylea, Edwina Light, Penelope Weller, Christopher Ryan, & Giles Newton-Howes
Event: 2023 The MHS conference - Adelaide
Subject: Factors Affecting Community Treatment Orders: An Overview of a National Research Project
Type of resource: Video
Community Treatment Orders (CTOs) have gradually become a standard feature of contemporary mental health service delivery in Australia and internationally. Despite hopes that CTOs might prevent relapse, minimise repeated, ‘revolving door’ admissions and provide support to families and carers of persons with a diagnosis of severe mental illness, evidence on these outcomes is equivocal. CTOs are also experienced as coercive by many consumers and a violation of their human rights. Meanwhile, many mental health care providers and family members support the use of CTOs but also express ambivalence about CTOs as a coercive mechanism that may be an unsatisfactory substitute for quality care.
We will open this symposium by presenting the latest International and Australian research on what is known about the impact of CTOs. The disproportionate use of CTOs to enforce treatment in relation to people of colour and those requiring interpreters, contribute to increasing concerns about the role of stigma, prejudice and discrimination in the implementation of CTOs. Some jurisdictions have acknowledged the human rights and equity problems with CTOs and have signalled attempts to reduce CTO usage through law reforms and changes to policy and practice. However, the evidence suggests that attempts to reduce CTO rates have had limited, if any, success.
CTOs are applied despite both the human rights concerns associated with their application and a lack of sufficient evidence that they are effective in achieving clinical outcomes). After outlining the problem of lack of evidence for CTO use, we move to discuss lived experience perspectives on CTO use. We will then introduce our preliminary findings regarding the current variations in the use of CTOs across and within jurisdictions in Australia.
Following this presentation of the evidence we will open up the discussion to symposium participants. Participants will be encouraged to form small groups with the purpose of bridging the gap between the existing knowledge of CTOs within and outside academia, and consider what further evidence needs to be generated. Participants will be invited to discuss the following questions:
• What do you already know about CTOs?
• What role might LE have in reducing the use of CTOs?
• What has your experience with CTOs been?
• Can CTO use be reduced or eliminated? How?
After small-group discussion, we will introduce a new 3-year ARC-funded project aimed at addressing some gaps in the evidence on the experience and efficacy of CTOs – FACTORS and report on our progress.
FACTORS aims to understand why there is significant variation in the application of CTOs across Australia. The project includes a consumer researcher and will recruit a lived experience advisory group to ensure that consumer perspectives are integrated into all aspects of the project. The project will collect administrative health data to determine which services use a high proportion of CTOs and those that use a low proportion. Then, field research will be done at high and low use services to understand what contributes to these rates. Simultaneously, legal scholars in our team will undertake research to understand how the legislation and its application might lend itself to inequitable application. We aim for this project to generate evidence that support attempts across Australia and internationally to reduce the use of CTOs.
To introduce the evidence regarding the implementation and impact of community treatment orders (CTOs)
To explore the current human rights concerns and gaps in knowledge regarding CTOs
Brophy, L., Edan, V., Gooding, P., McSherry, B., Burkett, T., Carey, S., Carroll, A., Callaghan, S., Finch, A., Hansford, M., Hanson, S., Kisely, S., Lawn, S., Light, E., Maher, S., Patel, G., Ryan, C.J., Saltmarsh, K., Stratford, A., Tellez, J.J., Toko, M. and Weller, P. (2018). Community treatment orders: Towards a new research agenda. Australasian Psychiatry, 1-4.
Corring, D., O'Reilly, R., & Sommerdyck, C. (2017). A systematic review of the views and experiences of subjects of community treatment orders [Review]. International Journal of Law and Psychiatry, 52, 74-80. https://doi.org/10.1016/j.ijlp.2017.03.002
Edan, V., Brophy, L., Weller, P., Fossey, E., & Meadows, G. (2019). The experience of the use of Community Treatment Orders following recovery-oriented practice training. International Journal of Law and Psychiatry, 64, 178–183.
Kisely S, Yu D, Maehashi S, et al. (2021) A systematic review and meta-analysis of predictors and outcomes of community treatment orders in Australia and New Zealand. Australian and New Zealand Journal of Psychiatry 55(7): 650-665.