Trust and Community Treatment Orders

John McMillan, Sharon Lawn, Toni Delany-Crowe

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


There are conflicting views about the benefits of community treatment orders (CTOs) for people with mental illness. While there is a significant literature on the coercive nature of CTOs, there is less on the impact that CTOs have upon trust. A recovery-oriented approach requires a trusting therapeutic relationship and the coercion inherent in the CTO process may make it difficult for trust to be built, nurtured, and sustained between workers and patients. Our aim was therefore to examine the role of trust within the CTO experience for mental health workers and patients on CTOs. Methods: We conducted a thematic discourse analysis of 8 in-depth interviews with people who were currently on a CTO and 10 interviews with multi-disciplinary mental health workers in Adelaide, Australia (total N = 18 interviews). The interviews were coded and analyzed with the assistance of a patient representative. The findings reveal the challenges and opportunities for trust within the coercive relationship of a CTO. Findings: We found that patients have diverse experiences of CTOs and that trust or mistrust played an import role in whether or not they found the CTO beneficial. I can have different kinds of trust: that you will treat me fairly, that you will have my interests at heart, that you will do me no harm. But if I do not trust your word, can I have genuine trust in the first three? If there is no confidence in the truthfulness of others, is there any way to assess their fairness, their intentions to help or to harm? How, then, can they be trusted? Whatever matters to human beings, trust is the atmosphere in which it thrives. (1, p. 31)

Original languageEnglish
Article number349
Pages (from-to)1-10
Number of pages10
JournalFrontiers in Psychiatry
Issue numberMAY
Publication statusPublished - 2019

Bibliographical note

Copyright © 2019 McMillan, Lawn and Delany-Crowe. This is an open-access article
distributed under the terms of the Creative Commons Attribution License (CC BY).
The use, distribution or reproduction in other forums is permitted, provided the original
author(s) and the copyright owner(s) are credited and that the original publication in
this journal is cited, in accordance with accepted academic practice. No use, distribution
or reproduction is permitted which does not comply with these terms.


  • mental illness
  • trust
  • patients
  • mental health workers
  • Engagement (involvement)
  • Vulnerability
  • Recovery
  • Trust
  • Community treatment orders


Dive into the research topics of 'Trust and Community Treatment Orders'. Together they form a unique fingerprint.

Cite this