Ambivalence about community treatment orders

The trend to endorse the use of outpatient commitment, or community treatment orders (CommTOs) (the terms are equivalent), seems to be gathering momentum. There is now some empirical evidence and a significant body of clinical opinion to suggest that CommTOs can affect clinical outcomes when properly established, resourced, and sustained. Their range has been extending in North America to cover New York and Ontario, for instance. Their introduction is actively under consideration in England and Wales (Department of Health, 2000). They are used extensively in Australia and New Zealand (Dawson, 1991; Dawson & Romans, 2001; Power, 1999; Vaughan, McConaghy, Wolf, Myhr, & Black, 2000). It seems CommTOs are now politically acceptable in many places.The general question we wish to pose about CommTOs is why, despite this gathering momentum, there remains such widespread ambivalence about their use. In addition, what are the reasons for this ambivalence? Does it flow only from the inadequate and conflicting nature of the evidence concerning their efficacy, or is the problem more fundamental and less easily resolved?Peer Reviewe