An analysis of the community treatment order system in New South Wales

Abstract

Aims: The use of CTOs in the management of people living with severe and enduring mental illness is both controversial and poorly understood. The study aimed to determine the factors that shape the operation of the CTO system in New South Wales and how the system might be improved. Methods: This empirical bioethics study undertook: a review of Australian national, state and territory mental health policies; a survey of rates of use of CTOs in Australian jursidictions; and in-depth interviews (n=38) with mental health consumers, carers, clinicians, and members of the Mental Health Review Tribunal of NSW. Main findings: • Mental health policies make little reference to CTOs. • CTO use in Australian jurisdictions vary enormously and rates are high by world standards. • Mental health consumers and carers experience distress and profound ambivalence in their experiences of CTOs. • GPs play an important role and face practical challenges. • CTOs are used to increase access to mental health services, but cannot remedy non-existent or inadequate services. • Conceptualisations of ‘risk’ and ‘capacity in this context revealed how people justify the use of CTOs. Conclusions: The problems identified in this research – CTO policy ‘invisibility’, data scarcity, and indistinct policy accounts about the role of CTOs and their justification – need to be addressed. This research helps us better understand how people think about and justify the use of CTOs, which is of importance to any policy reforms in this area.