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Compulsion in community mental health care: historical developments and current provisions 

Compulsion in community mental health care: historical developments and current provisions
Chapter:
Compulsion in community mental health care: historical developments and current provisions
Author(s):

Tom Burns

DOI:
10.1093/med/9780198788065.003.0002
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date: 08 December 2021

Compulsion has been a constant feature of psychiatry throughout its 200-year history and has always generated unease. Since deinstitutionalization a more assertive clinical approach has involved increased informal coercion. Community treatment orders (CTOs) have become a feature of most developed mental health services. Their origins are both political and clinical. This chapter outlines their variation, starting with the shift from the ‘least restrictive’ (preferred by civil rights activists) to ‘preventative’ (preferred by clinicians) approaches. It covers the range of legislations and notes the inexplicable variation in rates of use and the balance between public safety and patient benefit struck in different jurisdictions. It details the clinical characteristics of those subject to them, the range of conditions applied, and the differing approaches to enforcing those conditions. The ethical issues raised by the question of whether or not those on such orders are entitled to enhanced care are explored.

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