title: The subjective experience of community treatment orders: patients' views and clinical correlations.
abstract: BACKGROUND
  There is little objective evidence to support the use of community treatment orders (CTOs) from randomized controlled trials. Qualitative research indicates more negative than positive responses to the use of CTOs. Nonetheless, the use of CTOs is growing internationally. There is no research to identify for whom CTOs may be a positive experience.
  
  
  OBJECTIVE
  To assess patients' perspectives of CTOs, assessing for correlates with clinical and demographic variables.
  
  
  METHODS
  Patients currently or previously subject to a CTO were assessed quantitatively to identify their experience. Demographic data, the experience of coercion, views of detention, satisfaction with care, social functioning and psychopathology were correlated using SPSS.
  
  
  RESULTS
  Fifty-three per cent of patients felt that they were, on balance, better off when treated informally in the community. Patients described greater coercion and less satisfaction with care when subject to a CTO. These factors, and being in employment, identified patients whom felt harmed by CTOs 61% of the time.
  
  
  CONCLUSIONS
  This paper highlights that more than half of patients under a CTO consider it negatively. This group is identified by patients who work, experience coercion and are unsatisfied with care. This has implications for the application of CTOs.
authors.affiliation: Department of Psychological Medicine, University of Otago, New Zealand Department of Psychological Medicine, Imperial College, UK giles.newton-howes@otago.ac.nz giles.newton-howes@imperial.ac.uk.
authors.forename: Giles
authors.initials: G
authors.lastname: Newton-Howes
authors.affiliation: Whatever It Takes (WIT), Napier, New Zealand.
authors.forename: Doug
authors.initials: D
authors.lastname: Banks
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003134:Commitment of Persons with Psychiatric Disorders; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D017060:Patient Satisfaction; D016896:Treatment Outcome
keywords: Community treatment orders; capacity and consent; community mental health teams; ethics; psychiatry and law