Community Treatment Orders (CTO)

There is clearly a need in society when, under certain extreme conditions, a person’s liberty and basic human rights have to be curtailed for the greater good of society. Criminal law in a democratic society outlines these limitations and grants society the right to curtail freedoms.

In the context of behavioural disorders, there is a point when an individual becomes a danger to himself or others and where society has a responsibility to take appropriate action.   A man who indiscriminately attacks others whilst walking down the street is clearly a danger and if society does not grant the right to curb these actions then that society will obviously be an unsafe place to live.

However, such laws must be the least intrusive possible and due process must always be followed in their implementation. This structure is obviously in place in democratic societies but becomes a problem when the state (in the form of legislation or implementation) oversteps the ‘least intrusive’ guideline.

In the case of CTOs, we have clearly gone far beyound the “least intrusive” giving psychiatrists ultimate power to incarcerate people who have committed no crime, effectively jailing individuals indefinately until they comply to treatments or drugs.

“CTOs are likely to result in increased consumption of neuroleptic medication, since some patients who would formerly have exercised their right to refuse such treatment, will be unable to do so. These drugs are well known to cause occasional life threatening complications, a myriad of unpleasant side-effects for the patient, and irreversible neurological defects in a significant proportion of long-term users.” – Professor Joanna Moncrieff & Marceleno Smyth – Community Treatment Orders: A Bridge to Far


Every person, even an incarcerated criminal, has the right to his own integrity and physical well being.  Yet psychiatric ‘treatment’ goes far beyond the limitation of ‘least intrusive’ and psychiatrists are able to administer a strong electric current, cut out part of the brain or enforce mind-altering drugs on individuals under a fairly wide range of conditions. There are also issues that relate to incarceration or limitation of freedom due to psychiatric opinion and judgement. When this occurs, and when society does not meet its fundamental responsibilities in protecting the integrity and physical well being of others, then those responsible for such violations are at serious fault.

“Legislation has been introduced allowing doctors to coerce patients to take their drugs with threats of a return to hospital if they do not comply. Patients often find that their own understandings of their troubles are ignored. A study of psychiatrists in London found that, when patients asked questions about the meaning of their experiences, the doctors typically changed the subject.” – Professor Richard Bentall – The Guardian, 31 August 2009

“Fueled by fears for public safety and rationalized by an ethic of “doing good,” the belief among those who support CTOs is that they will protect society from dangerous mental patients, get treatment for those who routinely refuse help and reduce the need for hospitalization. However, no one knows for sure whether CTOs are capable of satisfying this list of objectives.” – Community treatment orders: The ethical challenge of coercive care published in Psychiatry Rounds, December 2000. Available through the Centre for Addiction and Mental Health

“CTOs will mean that people who are living and surviving in the community, who have committed no crime, and who are deemed competent enough to marry, vote and enter into business contracts, will be deprived of certain basic human rights enjoyed by the rest of the population. In particular, they will be unable to determine what happens to their own bodies and are likely to be forced to ingest psychotropic drugs on a long-term basis, against their wishes.” Professor Joanna Moncrieff & Marceleno Smyth – Community Treatment Orders: A Bridge to Far

“We always anticipated that there would be a year on year increase and that numbers of people under a CTO might rise to as many as 13,000 in 10-15 years’ time. However, we assumed there would be an equivalent reduction in in-patient numbers but that is clearly not the case at the moment. It certainly torpedoes the Department of Health’s expectation that CTOs will lead to potential savings through a reduction in bed use, with savings being invested elsewhere.” – Simon Lawton Smith, CEO Mental Health Foundation.

“In an international review of CTO outcomes, McIvor (1998) found little evidence that CTOs achieve their clinical goals.” Community treatment orders: The ethical challenge of coercive care published in Psychiatry Rounds, December 2000. Available through the Centre for Addiction and Mental Health

“The people who lose out, of course, are the ‘patients’ or service users, for whom the diagnosis is often an introduction into a lifetime of dependence on psychiatric services and toxic drugs, alienated from mainstream society by fear and stigma.”Lucy Johnstone, Academic Director, Bristol Clinical Psychology Doctorate.  Author ‘Users and abusers of psychiatry’, Routedge 2000