Shared Views on Improving Community Treatment Orders: A Qualitative Study in Ontario: Points De Vue Communs Sur L'amélioration Des Ordonnances De Traitement Communautaire : Une Étude Qualitative Réalisée En Ontario.

BackgroundPersons involved in compulsory mental health treatment-including clinicians, lawyers, service users, and family members-frequently express dissatisfaction with how the system is regulated and administered. Policy discussions on improving the system often fail to consider the voices of service users and family members. Policy development must also grapple with the contested values of autonomy and wellbeing, and the associated disjuncture in professional views. Community treatment orders (CTOs) are a key mechanism of compulsory mental health treatment in Ontario, and many other jurisdictions. We studied views on CTOs in Ontario to identify agreement across groups about where and how the system ought to be improved.MethodWe conducted semi-structured individual interviews followed by mixed focus groups including 72 participants: healthcare professionals, lawyers, tribunal members, service users ("clients"), family members, and advocates. Interview data were analyzed to identify recurring concerns and inform focus group discussion topics. Focus groups explored potential areas of alignment across participant groups, with particular attention to points of consensus. A lived-experience advisory panel informed study design.ResultsAcross participant groups, 6 main areas of agreement were visible. Participants identified the need for: (1) increased client involvement in treatment decisions, even within compulsory frameworks; (2) improved police involvement during CTO enforcement; (3) improved availability and quality of CTO-related data, enabling evaluation, accountability and attention to equity; (4) enhanced guidance and support for substitute decision-makers; (5) stronger oversight of medical decision-making, though preferred mechanisms varied; and (6) expanded community services-particularly housing, addiction treatment and case management-viewed as essential for CTOs to be able to have their intended benefit.ConclusionsThis study shows there is meaningful agreement on several areas requiring improvement in Ontario's CTO system. These points of convergence represent promising foundations for policy development, although translation into actionable reform will require further policy work.