Community treatment orders: An in-depth exploration of care planning

Community treatment orders (CTOs) remain contested in their efficacy and rationale for use. Regardless of the debate, consumers, carers, and clinicians are frequently required to engage within this context. CTO legislation states that treatment and care should be recovery-focussed, though care is often coercive. Positive gains for individuals come at a cost. This study sought to understand the interpersonal and broader systems issues that impact on the care planning process. Ethnographic methods of observation and interview provided a detailed account of the multi-92perspectives of consumers on CTOs, their families, and treating clinicians, over an 18-monthperiod in a community mental health team in Adelaide, Australia. Clinicians, consumers, and family members face various conundrums in this space that can be disempowering for all involved. Risk, a primary driver of CTO use, impacts on language used, the conceptualization of individuals in clinical reviews (as ‘cases’), care pathways, and worker options. Opportunities for workers to reflect on these issues has the potential to change practice at an individual and eventually cultural level, with the aim of improving care experiences and outcomes for consumers on CTOs, as well as improving worker experiences.