Has the time come to abandon coercive community treatment in mental health?

Sascha Callaghan1, Giles Newton-Howes2

1 Faculty of Law, University of Sydney NSW 2006, Sascha.callaghan@sydney.edu.au
2 Department of Psychological Medicine, University of Otago, Wellington, New Zealand.

COMMUNITY TREATMENT ORDERS (CTOs) emerged as an alternative to involuntary inpatient treatment for mental illness in the 1970s, alongside the broader deinstitutionalisation movement for people with disabilities.  At that time CTOs were embraced as an innovative, “less restrictive” alternative to involuntary inpatient orders for people with chronic and severe mental illness, and met community concerns about the potential for neglect of mentally ill people in the community.  Now, after three decades of practice, the overwhelming conclusion of numerous studies is that CTOS ARE NOT EFFECTIVE in achieving their main clinical aims.  In addition, the goals of the disability rights movement in mental health now insists that the will and preferences of people with mental illness must be respected in any decisions about treatment.  The QUESTION THEREFORE ARISES WHETHER THEIR CONTINUED USE CAN BE JUSTIFIED.  This article argues that they cannot, if the goals of non-discrimination and supported decision-making enshrined in the CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES are to be taken seriously by states parties, including Australia and New Zealand. We argue that the CTO system was based on goals that were both normatively and epistemically flawed, and compliance with INTERNATIONAL HUMAN RIGHTS LAW now requires that they be abolished.


Dr Newton-Howes is a senior lecturer in the department of psychological medicine, Wellington and a consultant psychiatrist and clinical leader for Te-Upoko-me-te-Whatu-o-Te-Ika, the mental health alliance of Capital and Coast, Hutt Valley and Wairarapa DHB’s.  He completed his medical training at Otago before completing his psychiatry training at Imperial College, London.  He is a general adult psychiatrist with a subspeciality in substance misuse psychiatry.

Since his appointment in 2013 he has focused his research activities in three areas: the epidemiology and treatment of addiction, the intersection of personality and mental state disorder and the interface between psychiatry and society.  Since his appointment he has published in a number of general and specialist journal including the BJPsych, the Lancet and Addiction.  He has been an invited speaker internationally in these areas.  He has received grant funding from internal and external sources to support this.  Dr Newton-Howes acts as a systematic reviews editor for BJPsych and sit on the board of BJPsych, BJPsych Bulletin and the specialist journals Personality and Mental Health and the International Journal of Mental Health and Capacity Law of which he is one of the founding editors.


Sascha Callaghan is a lawyer and lecturer in health law and ethics at the University of Sydney. She has published widely in the area of health care decision-making, mental health and disability rights. She is also the lead researcher in the Sydney Neurolaw Project, a project that investigates intersections between neuroscience, law and ethics.

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