'Traumatic to Say the Least; It Still Affects Me': Consumer Perspectives on Community Treatment Orders in Australia

Community Treatment Orders (CTOs) are contested practices in mental healthcare due to unresolved evidence of effectiveness and persistent human rights concerns. Despite this, Australia has high rates of CTO use internationally. Research from a lived and living experience (LLE) perspective remains limited.

This mixed methods research explored experiences of people with LLE of mental ill-health and being on a CTO ('consumers'). An online survey including Likert-rated, categorical and open-ended questions was disseminated across Australia in 2024 to consumers aged 18 years or over. Quantitative data were reported descriptively, and qualitative data were analysed using Latent Content Analysis.

Forty-three people completed the survey; most identified as female (86%); 51.2% were aged 30-49 years; 7.2% were currently on a CTO; 40.5% had been on a CTO in the past 1-5 years; and 45.2% had been on a CTO more than once. Automated data contamination ('bot') infiltration hampered inclusion of further data. Participant responses included: (1) experiences prior to being on a CTO; (2) experiences whilst on a CTO; (3) attitudes towards CTOs; (4) family involvement; and (5) views on mental health services. While some consumers reported experiencing positive care, many rejected use of CTOs, reporting coercion, exclusion from decision-making and information, lack of alternative support options, and lack of compassion.

Policy and practice reforms, including focus on recovery and human rights, appear to have failed to improve experiences of CTOs. Further work to close the policy-practice gap and translate policy into more inclusive, human rights-based care is indicated.

This project has included considerable involvement and community engagement with people with lived and living experience ('LLE') of CTOs and/or mental health service use in all phases of the project. The project includes two Chief Investigators who identify as LLE leaders and researchers (VE and SL), and who have direct lived experience of CTOs, or as a family/caregiver of individuals who have direct lived experience of CTOs. The project manager (TZ) and some project staff (TS, TK, and PS) are LLE researchers, and the project is guided by a Lived Experience Advisory Panel (LEAP) with LLE experience of CTOs, including both service users and family/caregivers. We also have LLE experts on our project's international advisory panel. Together, their contributions have been vital in the project team's open and transparent reflections on their diverse perspectives and positioning which have grounded the project's focus on LLE perspectives.