Involuntary treatment orders (ITOs) represent coercive leverage for treatment adherence against the will of individuals incapable of providing consent. ITOs have failed to demonstrate benefits in quantitative studies, but little attention has been paid the growing body of qualitative evidence on ITOs. The current study is an interpretative meta-synthesis designed to integrate qualitative evidence and enhance our understanding of stakeholders' perspectives (service users, relatives, professionals, psychiatrists) of ITOs in the context of mental health care. Forty-four studies met the following inclusion criteria, peer-reviewed empirical qualitative studies, and focus on perspectives and experiences of ITOs in a mental health context. Themes resulting from the analysis are: an ITO as leverage to manage compliance and risk; legal concerns; learning to play the game; building a therapeutic relationship in a coercive context; positive and negative impacts of ITOs; family involvement; and discharge. Based on these themes, an exploratory model of ITOs is proposed.

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This paper argues that the principal human rights and policy concerns that have been raised over criminalisation of HIV exposure or transmission since the early days of the epidemic cannot be neatly addressed within the traditional criminal law framework. Public health structures may be better placed, in terms of both their mandate and their structure, to incorporate lessons from the public health and human rights movement. This paper critically explores the potential of emerging models of structured coordination between public health and criminal law actors with a view to a more targeted, human-rights-sensitive application of criminal law to the sexual behaviours of people living with HIV. Finally, it assesses these emerging approaches from new governance and restorative justice perspectives.

The COVID-19 pandemic—with its wide-reaching social, political, and economic implications—showcases the importance of public health governance. Governmental accountability is at the forefront of societal preoccupations, as state actors attempt to manage the pandemic by using sweeping emergency powers which grant them significant discretion. Though emergency measures have tremendous impacts on citizens’ lives, elected officials and civil society have little input in how governments wield these powers. We reviewed available mechanisms in Canadian private, constitutional, and criminal law and found them to be unlikely sources of much-needed accountability. Therefore, we propose that provincial and territorial legislatures modify public health legislation to expand mechanisms to foster public confidence in decision-makers, and bolster accountability to parliaments and citizens.

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