How shortcomings in the mental health system affect the use of involuntary community treatment orders

Objective: The aim of the present study was to examine stakeholder perspectives on how the operation of the mentalhealth system affects the use of involuntary community treatment orders (CTOs).Methods: A qualitative study was performed, consisting of semi-structured interviews about CTO experiences with38 purposively selected participants in New South Wales (NSW), Australia. Participants included mental health consumers(n = 5), carers (n = 6), clinicians (n = 15) and members of the Mental Health Review Tribunal of NSW (n = 12). Data wereanalysed using established qualitative methodologies.Results: Analysis of participant accounts about CTOs and their role within the mental health system identified twokey themes, namely that: (1) CTOs are used to increase access to services; and (2) CTOs cannot remedy non-existent orinadequate services.Conclusion: The findings of the present study indicate that deficiencies in health service structures and resourcing area significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntaryand involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulatingCTO implementation