title: Community treatment orders in New Zealand: regional variability and international comparisons.
abstract: OBJECTIVE
  Community treatment orders (CTOs) have been used in New Zealand since 1992 and are now used in most Commonwealth countries. There is little research on the rate of use of CTOs in New Zealand. This study compares the prevalence of CTO use across New Zealand's 20 health districts and makes comparisons with international prevalence rates.
  
  
  METHODS
  New Zealand Ministry of Health reports provided data on rates of CTO use in New Zealand between 2005 and 2011. International rates were obtained from published reports and academic literature on CTO use.
  
  
  RESULTS
  Rates of CTO use in New Zealand show marked and persistent regional variation over the period of data collection. National average rates increased from 58 per 100,000 in 2005 to 84 per 100,000 in 2011. Rates of use of CTOs are increasing internationally. New Zealand's CTO use is high by international comparisons.
  
  
  CONCLUSIONS
  New Zealand's high and increasing rate of CTO use by international standards raises questions about the delivery and functioning of mental health services, and about mental health service users' experience of mental health care. The high rate of CTO use needs to be addressed as a human rights issue as well as a clinical issue.
authors.affiliation: Centre for Mental Health Research, University of Auckland, Auckland, New Zealand a.obrien@auckland.ac.nz.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: O'Brien
keywords: Community treatment order; coercion; community mental health; human rights; mental health legislation