Community treatment orders - what are the views of decision makers?

BACKGROUND: Community treatment orders (CTOs) are being increasingly used in Western countries. The scheme implies that mental health patients can live outside a hospital, but still be subject to coercive care to ensure compliance with their treatment. There is limited knowledge of how the scheme is practised.

AIMS: To gain knowledge of how decision makers weigh and evaluate various considerations when making decisions on CTOs.

METHOD: Qualitative in-depth interviews with decision makers responsible for CTOs in Norway.

RESULTS: Decision makers viewed CTOs as a useful scheme to ensure control, continuity and follow-up care in the treatment of outpatients with a history of poor treatment motivation. They had varied interest in and knowledge of the patient's life situation and how the scheme affects the patient's everyday life. Little attention was devoted to patient experiences of formal and informal coercion.

CONCLUSION: When deciding on CTOs, decision makers should pay more attention to the negative consequences that patients may experience. In many cases, decision makers are probably not aware of these coercive factors.