Community Treatment Orders (‘CTOs’) are legal orders for a person to receive compulsory mental health treatment, as authorised by legislation, without a person’s consent. These orders have been continually rising over the years despite this form of ‘treatment’ generally being limited to use during arrests, hospital stays, and forced medication. This paper will argue that CTOs are ineffective, counterproductive, discriminatory and a hindrance to recovery.
Although the imposition of CTOs operates as the NSW health and criminal justice system’s current response to persons seen as a threat to themselves or others, particularly in cases concerning an individual with a history of refusing treatment, their wide scope and intrusive nature enables significant opportunity for misuse and abuse. This is specifically evident in NSW where legislation and practices associated with CTOs are misaligned with those of other Australian states. A 2023 study demonstrates that NSW has one of the highest rates of imposing CTOs worldwide, with 6,767 instances of CTOs issued in 2022 alone. The broad applicability and criteria of CTOs have allowed them to be made into a tool for control rather than a method for rehabilitative recovery focusing on individual needs and the best interests of mental health consumers.
The introduction of CTOs as instruments for deinstitutionalisation is highly problematic as community services are often inadequately funded and the overarching policy lacks transparency and a comprehensive system of accountability. Further, CTOs are coercive and anti-therapeutic as they remove all elements of personal autonomy for individuals with mental illness. The real potential for discrimination and counterproductive outcomes for affected individuals is incredibly detrimental to their wellbeing. Studies have proven the ineffectiveness of CTOs; 85 orders are required in order to prevent 1 readmission, 27 orders to prevent 1 case of homelessness, and 238 orders to prevent 1 arrest. CTOs only further the misconception that mentally ill incarcerated persons are dangerous people who are behaviourally unpredictable and incapable of making decisions for themselves.
The use of CTOs in prisons, also known as Forensic CTOs (‘FCTOs’), is unjustified and oppressive. Introduced into NSW in 2011, the primary purpose of legislating FCTOs is for convenience, resulting in an average annual increase of 4% since the 2017/18 period. This further demonstrates the ongoing failure of NSW public policy and practices, given that there is an obligation in NSW for affected incarcerated persons to be transferred to a hospital and receive proper care, which is not occurring due to replacement with CTOs. Prisons now have overwhelming authority to forcibly medicate incarcerated persons under the guise of a CTO, functioning as an extended form of ‘prisoner punishment’. This extrajudicial punishment of incarcerated persons, aside from being highly unethical and unjust, has resulted in distrust between prison/medical personnel and incarcerated individuals. This form of coercive control should not be tolerated as it directly conflicts with fundamental human rights afforded to all persons.
Recent case studies, as discussed in this report, highlight the coercive effects of CTOs. These case studies, in the context of legal frameworks and research conducted in this area, evidence the criticisms of CTOs. The examination of CTOs in this report makes these orders’ stringent and invasive nature abundantly clear. Most notably, CTOs infringe on an individual’s autonomy, freedom and self-determination. Although CTOs serve as an alternative to incarceration in NSW and other Australian states, their restrictive form of compulsory treatment can be seen as a form of detention due to their ability to significantly impede upon a person’s life. In addition, there is no conclusive evidence that CTOs are greatly beneficial or effective, yet it can be shown that CTOs instead encourage the stigmatisation of people with mental illness.
Alternatives to CTOs, such as access to consumer workers and the option of establishing a directive, should be considered in place of CTOs to not only work towards reducing the continued stigma that comes with mental illness but also provide the individual with an opportunity to possess some control over their impending treatment when they are of sound mind. Research derived from other countries that have successfully instituted these alternatives to CTOs evidences their effectiveness and the importance of allowing individuals a sense of autonomy as opposed to implementing means of forced medication. Therefore, CTOs in Australia are not fit for purpose and must be reevaluated in order to be used as a valuable tool in rehabilitating individuals with mental illness.