SummaryBackground Compulsory supervision outside hospital has been developed internationally for the treatment of mentally ill people following widespread deinstitutionalisation but its effi cacy has not yet been proven. Community treatment orders (CTOs) for psychiatric patients became available in England and Wales in 2008. We tested whether CTOs reduce admissions compared with use of Section 17 leave when patients in both groups receive equivalent levels of clinical contact but diff erent lengths of compulsory supervision.

Users' advance instruction directives had little observable impact on the outcome of care at 12 months.

The enactment of a single legislative scheme governing nonconsensual treatment of both 'physical' and 'mental' illnesses, based on incapacity principles, has been mooted in recent law reform debates in the UK. We propose a framework for such legislation and consider in more detail the provisions it should contain. The design of legislation that combines the strengths of both incapacity and civil commitment schemes can be readily imagined, based on the criteria for intervention in England and Wales found in the Mental Capacity Act 2005. Such legislation would reduce unjustified legal discrimination against mentally disordered persons and apply consistent ethical principles across medical law.

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The usefulness of community treatment orders is accepted by most patients under them in NZ, as well as by most psychiatrists. Critical factors include the quality of therapeutic relationships and the structure provided for community mental health care.