title: Involuntary outpatient treatment for mental health problems in Switzerland: a literature review.
abstract: BACKGROUND
  In 2008, the Swiss Civil Code was amended. From 1 January 2013, each Swiss canton may propose specific provisions for involuntary outpatient treatment (community treatment orders (CTOs)) for individuals with mental disorders.
  
  
  OBJECTIVE
  This review catalogues the legal provisions of the various Swiss cantons for CTOs and outlines the differences between them. It sets this in the context of variations in clinical provisions between the cantons.
  
  
  METHODS
  Databases were searched to obtain relevant publications about CTOs in Switzerland. The Swiss Medical Association, Swiss Federal Statistical Office, Swiss Health Observatory and all the 26 Cantonal medical officers were contacted to complete the information. Conférence des cantons en matière de protection des mineurs et des adultes (COPMA), the authority which monitors guardianship legislation, and Pro Mente Sana, a patients' right association, were also approached.
  
  
  RESULTS
  Three articles about CTOs in Switzerland were identified. Psychiatric provisions vary considerably between cantons and only a few could provide complete or even partial figures for rates of compulsion in previous years. Prior to 2013, only 6 of the 20 cantons, for which information was returned, had any provision for CTOs. Now, every canton has some form of legal basis but the level of detail is often limited. In eight cantons, the powers of the measure are not specified (for example, use of medication). In 12 cantons, the maximum duration of the CTO is not specified. German speaking cantons and rural cantons are more likely to specify the details of CTOs.
  
  
  CONCLUSIONS
  Highly variable Swiss provision for CTOs is being introduced despite the absence of convincing international evidence for their effectiveness or good quality data on current coercive practice. Careful monitoring and assessment of these new cantonal provisions are essential.
authors.affiliation: Social Psychiatry Group, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK Service de Psychiatrie Communautaire, Département de Psychiatrie, Université de Lausanne, Lausanne, Switzerland stephane.morandi@chuv.ch.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Morandi
authors.affiliation: Social Psychiatry Group, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Burns
mesh_terms: D000553:Ambulatory Care / Q000331:legislation & jurisprudence* / Q000379:methods / Q000523:psychology*; D003153:Community Health Services / Q000331:legislation & jurisprudence* / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D010045:Outpatients / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D013557:Switzerland / Q000453:epidemiology
keywords: Community treatment order; Switzerland; coercion; involuntary outpatient treatment; legislation; mental health