Involuntary Treatment

The community treatment order study


Risk, capacity and making decisions about CTOs

The two customary justifications for ‘involuntary’ or ‘coercive’ treatment of mental illness are either: that without treatment the mentally ill person might be likely to seriously harm themselves or others or; that the person lacks capacity to refuse treatment but that treatment would be in the person’s bests interests and consented to by a substitute decision-maker.

These concepts of ‘risk’ and ‘capacity’ are complex in the setting of community mental health care as levels of acuity and clarity of risk are often viewed through different prisms by diverse stakeholders. The lack of any valid consensus on models of ‘risk’ and ‘capacity’ often complicates clinical and legal decisions relating to the use of involuntary community treatment orders (CTOs).

Between 2009 and 2012, the Centre for Values Ethics and the Law in Medicine (VELiM) at the University of Sydney conducted a qualitative research program on behalf of the Mental Health, Drug and Alcohol Office (MHDAO) of NSW Health.
The study aimed to:
- identify how mental health professionals, consumers, carers and Mental Health Review Tribunal (MHRT) members conceptualise ‘risk’ and ‘capacity’ in the context of CTOs, and how these concepts influence CTO decisions,
- develop comprehensive models of ‘risk’ and ‘capacity’ that serve as a basis to improve decision-making.

The findings of this project are reported here:
Risk, capacity and making decisions about CTOs - a report from 'the CTO study'



The lived experience of consumers and carers

A specific arm of the CTO project was a study of lived experiences of consumers subject to CTOs and carers. There is limited research examining the lived experiences of CTOs – several overseas studies provide some insight but little such research exists in Australia and none has been conducted in NSW.

The VELiM CTO study, conducted on behalf of the MHDAO of NSW Health, sought to describe the lived experience of CTOs from the perspectives of mental health consumers and their carers. The project aimed to use the findings from this lived experience arm of the research to inform improvements to clinical and legal decision-making about CTOs.

The findings of this project are reported here:
Community treatment orders: the lived experience of consumers and carers in NSW