McIvor R
Alma Street Centre, Fremantle Hospital and Health Service, Australia.
Aust N Z J Psychiatry. 1998 Apr;32(2):223-8. doi: 10.3109/00048679809062732.
In the light of recent legislation, this paper reviews the implementation of the Community Treatment Order (CTO) in terms of clinical efficacy and ethical issues involved in its use. The debate surrounding the introduction of CTOs in other countries is explored.
A Medline search was conducted and references of recent articles followed up, with attention to Australian, New Zealand and international trends. A review of relevant legislation and government reports was conducted.
There has been limited debate in the Australian and New Zealand literature concerning the operation of CTOs. Despite their increasing and widespread use, there is a paucity of research on the efficacy of CTOs. Concerns about their negative effects on civil liberties have been stressed in the United Kingdom and American literature.
If the continued use of CTO is to be justified, both clinically and from the civil liberties perspective, controlled research needs to be carried out to identify whether CTOs are more effective than comprehensive assertive community outreach programs in reducing relapse rates and hospitalisation, and increasing compliance. Clinical guidelines concerning who is most likely to respond to such orders need to be developed. Alternatives to the CTO are explored, and future directions in research are outlined.
鉴于近期的立法，本文从临床疗效及其使用中涉及的伦理问题方面对社区治疗令（CTO）的实施情况进行综述。探讨了其他国家围绕引入社区治疗令的争论。
进行了医学文献数据库（Medline）检索，并追踪近期文章的参考文献，关注澳大利亚、新西兰及国际趋势。对相关立法和政府报告进行了综述。
澳大利亚和新西兰的文献中关于社区治疗令实施情况的争论有限。尽管其使用日益广泛，但关于社区治疗令疗效的研究却很少。英国和美国的文献强调了对其对公民自由产生负面影响的担忧。
若要从临床和公民自由角度证明继续使用社区治疗令的合理性，就需要开展对照研究，以确定社区治疗令在降低复发率和住院率以及提高依从性方面是否比全面的积极社区外展项目更有效。需要制定关于谁最可能对这类命令有反应的临床指南。探讨了社区治疗令的替代方案，并概述了未来的研究方向。
