As a participant in their application in the State of Victoria, Australia, over the past four years, I have increasingly appreciated their immense value as an effective means to safeguard the health and welfare of chronically relapsing patients. Psychiatry currently has only limited success with this group, but it can be substantially more helpful when in a position to ensure that patients comply with the treatment they have been given.
The experience of witnessing the ordeal of young schizophrenic patients who, tortured by their psychosis, require urgent admission to a psychiatric hospital time and time again and become thoroughly disillusioned and demoralised, has persuaded me that the benefits of a community treatment order (the terminology used in Victoria), for both patients and their families, in carefully selected cases, outweigh the admittedly serious cost of curtailing civil liberties.
I would argue that the severely mentally ill have a right to be cared for when not fully competent to act appropriately in their own interests, and society has a corresponding responsibility to provide that care.
If we claim that community care is preferable to long-term institutionalisation, then psychiatry must be given the practical means to carry out its mandate.
Our experience in Victoria points to the utility of the community treatment order in providing the best possible care, while at the same time helping patients to integrate into the community.
Associate Professor and Reader in Psychiatry
University of Melbourne
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