Factors Affecting Community Treatment Orders Research Study: Understanding variation in CTOs

Introduction: There is international evidence that forced community treatment in the form of community treatment orders (CTOs) is applied arbitrarily within and across jurisdictions, disproportionately affecting marginalised groups. FACTORS aims to explain the drivers underpinning these variations. This presentation is an overview of the study and a summary of preliminary findings.

Methods: FACTORS is a mixed methods project with several arms including qualitative analysis of routinely collected administrative data, analysis of legal and policy documentation, and a qualitative study of services that have high and low rates of CTO use. FACTORS incorporates lived experience perspectives through including a consumer lead investigator, research fellow, and lived experience advisory panel.

Results: The legal and policy analysis already indicates that jurisdictions in Australia vary in relation to alignment of legislation with the UNCRPD and the emphasis placed on people having capacity. We have found that there is a lack of policy to guide practice and implementation in some jurisdictions– and an abundance in others. Administrative health data has been difficult to obtain for a study of this size and complexity and each jurisdiction has required a bespoke approach to the application.

Discussion: Undertaking a large-scale investigation of CTO implementation has significant challenges. CTOs have tended to be invisible in discussions about mental health reform in Australia and the early stages of FACTORS is revealing why this is the case. Lack of monitoring and accountability may be contributing to the amount of variation in the use of these orders that lead to a significant impact on human rights and the very nature of mental health service delivery.

Conclusion: The data associated with the FACTORS project will generate social and cultural benefits for those directly affected and the broader community, and to create new knowledge and innovate law and policy processes.