The Urgent Need to Review the use of CTOs and Compliance with the UNCRPD Across Australian Jurisdictions

Abstract

In every Australian jurisdiction, legislation permits mental health service providers and/or mental health tribunals to force people with mental illness to engage in treatment, under Community Treatment Orders (CTOs). Despite considerable efforts made by every Australian state and territory to meet human rights obligations under the United Nations Convention on the Rights of Persons with Disabilities (CRPD) (2008; Maylea & Hirsch, 2017), Australia has rates of CTO usage that are very high by world standards (Light, 2019). Even within Australia, rates of CTO usage vary considerably between and within jurisdictions in spite of the legislation being very similar (Light, 2019; Adult mental health quarterly KPI report, 2019). This occurs in the context of mixed evidence about the efficacy of CTOs and a lack of clear understanding of their purpose (Segal et al., 2017; Kisely et al., 2017). The use of CTOs remains one of the most contentious issues in mental health service delivery. Not only is their efficacy unresolved, they also raise serious ethical and human rights concerns. The current debates, and attempts at reform, must be informed by valid and reliable data. This brief commentary will make the case for a research agenda that addresses the minimal research that has been undertaken to address the variations of CTO use across Australian jurisdictions.

Benefits following community treatment orders have an inverse relationship with rates of use: meta-analysis and meta-regression

“…This is because mental health acts (MHAs) across Australia and New Zealand are very similar and, unlike in these other jurisdictions, they are not influenced by entrenched human rights instruments that potentially constrain MHA powers. [5][6][7] The central features of CTOs in Australia and New Zealand are the duty on patients to accept psychiatric treatment and clinician appointments, as well as directions on their type of accommodation in some cases. 6 The legislation also gives powers to provide treatment without consent and to enter someone's accommodation or recall them to hospital (with or without police assistance).…”