The first Indo-European Symposium on Coercion hosted by Mysore Medical College brought to limelight the often ignored  aspects of various forms of coercion in psychiatric practice. The Session on  Community Treatment Order (CTO) featured talks by two eminent speakers- the audio excerpts of which can be accessed below.

1. Talk by Prof. Mohan Issac (The University of Western Australia, Formerly Professor & HOD Dept of Psychiatry, NIMHANS) covers What is CTO, How It came to being, What are the benefits, shortcomings and controversies associated with CTO and Whether CTO are relevant and useful in India.

2. Talk by Prof. Peter Lepping (Medical Director BCULHB, North Wales Visiting Professor Glyndw^r University Wrexham. UK) covers general guidelines for clinicians on CTO.

During the interactive part of the session it was discussed that the law in general infact permits use of moderated and supervised coercion like that in the order for inpatient commitment for patients who are in danger to themselves and to others (Reception order MHA India 1987) -similarly the CTO is one innovative use of the same for outpatient treatment for certain subset of patients who might benefit from it. One discussant drew a parallel between the DOTS therapy for tuberculosis and CTO. CTO can be a clinically useful tool if skillfully and judiciously  used by the clinician.And finally here is also an independent select textual overview and criticism of CTO curated from the web.

Courtesy: 

More recent data on CTOs.

1. RCT finds that CTOS do not reduce hospital readmissions.

2. Talk by Prof. Lepping during the IPZ southzone online practitioner’s cme on 30th August 2020:  one RCT cannot say everything..study has its limitations..besides, it infact shows benefit for the severely ill (the subset for whom CTOs should be used actually). CTOs in India the family can act as the agent that will police the CTO, but then families may use it as a license to use it for as thet feel like than for what it intended for by the treatment team..when legislating CTOs the key consideration need to be on what to do when there is non compliance with CTOs that need to be written very specifically. In England the action is to send reminder, letter and last recall by police…SMART criteria by lepping and malik 2013 (specific, measurable, achievable, realistic, timeframed)..this will be guide clinicians when drafting specific CTO criteria. [ historical background: lunacy act dealt with `vagrancy and property issues, Mental health act is early 20th century were concerned with asylums, MHA of late 20th century moved to hospital based treatment rather than community, changes in 21st century try to address issues of non compliance in the community]