Compulsory community treatment and admission rates

We fully agree with Kisley et al (2004) that the patients receiving compulsory community treatment are often relatively young, male, single, Black or from a minority ethnic group, unemployed and with a history of schizophrenia, drug use, previous admissions and forensic contact. They obviously are more severely unwell and more liable to be readmitted than are those who are treated without compulsory treatment orders (CTOs). Therefore, it would have been more appropriate to compare the patients on CTOs with individuals whose applications for CTOs were not granted by the family courts (as in New Zealand), or who were discharged by the Mental Health Review Boards (as in Australia).

In our experience, a patient's non-adherence with treatment is a common reason for the psychiatrist to consider compulsory treatment in the community. In this respect, the clinical experience of psychiatrists in New Zealand has been satisfactory as 69.2% reported that CTOs were a useful tool for promoting community treatment for people with mental illnesses (Currier, 1997). On the other hand, there is a paucity of conclusive findings and qualitative research into the experience of patients, carers and professionals regarding compulsory community treatment, with respect to how it may impact upon civil liberties and, in particular, future engagement with mental health services (Moncrieff & Smyth, 1999), which is of concern.