Ensuring compulsory treatment is used as a last resort: A narrative review of the knowledge about Community Treatment Orders

Community treatment orders (CTOs) have become a standard feature of contemporary mental health care worldwide, even though those placed under them typically perceive them as coercive. This review of the literature found that the evidence regarding the impact of CTOs is mixed and contested. Despite concerns about the overuse of CTOs, there were no examples found of projects that have aimed to achieve a reduction in the use of CTOs that have proved successful. Literature on attempts to reduce CTOs is largely grey literature and so lacks the evidence base that is present in literature on the efficacy of these orders. Our review found that changing attitudes, preparing services and staff for practice change, and supporting the implementation of innovative alternatives need to be addressed in working towards reduction in CTO use. Several sources highlighted that lived experience perspectives should have a key role in driving reform.