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Front Psychiatry. 2019 May 20;10:349. doi: 10.3389/fpsyt.2019.00349. eCollection 2019.

Trust and Community Treatment Orders.

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Bioethics Centre, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, SA, Australia.
College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.


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.


community treatment orders; engagement (involvement); recovery; trust; vulnerability

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