What clinicians say about the experience of working with individuals on community treatment orders

Abstract

Objective: Community treatment orders (CTOs) refer to a variety of legal schemes that require a person with a serious mental illness to follow a plan of treatment and supervision while living in the community. Use of CTOs has been controversial, and they have been the subject of a considerable amount of quantitative and qualitative research. This article reports the results of a systematic review of qualitative studies focused on understanding the views and experiences of clinicians who work with individuals on CTOs. Methods: Relevant databases and gray literature were searched for articles that used a qualitative methodology for data collection and analysis to examine clinicians’ perspectives. CTOs were defined as various legal schemes, including court-ordered outpatient commitment and renewable conditional-leave provisions initiated while a person is an inpatient in a psychiatric unit. Mandatory treatment and supervision required after a person has been charged with or convicted of committing a criminal offense was not considered. Results: Fourteen articles met inclusion criteria. They represented the views of more than 700 clinicians from six international jurisdictions. Three themes were identified: endorsement of the benefits of CTOs despite tensions both within and between clinicians concerning several aspects of CTOs; belief that medication compliance is a central aspect of CTOs; and acknowledgment that there is room for improvement in CTO implementation, monitoring, and administration. Strategies for reducing tensions and improving administration of CTOs are discussed. Conclusions: Clinicians view CTOs as providing benefits to their clients but struggle with the coercive nature of these tools.