Abstract
Objective:Involuntary treatment in the community has become an increasing and accepted part of the landscape of mental health service delivery. Community Treatment Orders (CTOs) or Outpatient Commitment (OPC) may be understood to be an inevitable consequence of the process of deinstitutionalisation and an acceptance that many clients are at constant risk in the community and may require long-term involuntary treatment. However, there are important social, economic and political imperatives influencing CTOs; this article explores these driving forces and identifies the concerns of the critics of involuntary treatment in the community.
Methods:Using the concept of force field analysis, the driving and restraining forces surrounding the development and implementation of CTOs are identified.
Results: All Australian states and territories now have provision for involuntary community treatment. However, despite an increasing reliance on, and to some extent, acceptance of, the validity of involuntary community treatment in mental health, these developments are not uncontested. Consumer groups, legal advocates and service providers have questioned the use of involuntary treatment in the community and identified various concerns, including the potential for human rights abuses, ethical dilemmas and doubts regarding effectiveness.
Conclusions: The paper concludes by arguing for stronger evidence base to support the use of CTOs. In doing so it focuses on the social, policy, legal and ethical context within which CTOs are implemented.