Community Treatment Orders and Leveraged Treatment

The use of leveraged treatment pressures to promote adherence with community-based mental health treatment among people with serious mental illness (SMI) is a common albeit controversial practice. It frequently involves using the social welfare and legal system to pressure people with a SMI to adhere with treatment.

Supporters of this approach suggest such practices serve to improve engagement and treatment adherence among people with SMI who have challenges in voluntarily complying with prescribed treatment and ultimately promote personal autonomy by reducing illness relapse and preventing hospitalization.

Critics of this approach argue such practices could impinge on civil liberties, harm the therapeutic relationship, contribute to stigma, and undermine self-determination and the goal of reclaiming a meaningful life.

Treatment pressures include a number of practices that lay along a continuum of coercive measures ranging from subtle interpersonal interactions to compulsory treatment. A common form of compulsory treatment are community treatment orders (CTOs).

A CTO is an order issued by a physician and agreed to by an individual (and/or their Substitute Decision Maker) which requires the individual to receive care and treatment in the community, in lieu of detention in a psychiatric facility. CTOs are used with individuals.