{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:26:21Z","timestamp":1785432381484,"version":"3.56.0"},"reference-count":40,"publisher":"Royal College of Psychiatrists","issue":"4","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec id=\"S2056472426120158_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Community treatment orders (CTOs) permit compulsory mental healthcare outside hospital. Such orders have become part of an increasing number of mental health laws, even if there is a lack of consensus on their effects, negative personal experiences, diverging ethical positions and expectations that governments should reduce or abandon coercive practices. It is therefore surprising that there is limited research describing the availability and restrictiveness of CTO legislation, and we found no comprehensive European study. Such studies could contribute to clarification of differing positions and, through that, informing further research and discussions of how to promote voluntary options in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120158_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To establish the availability of CTO legislation across Europe, and how regimes in different ways restrict the person.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120158_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Data were collected from 33 European countries through a network of researchers and practitioners, and links to relevant legislation were provided.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120158_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We found 13 CTO regimes across the 33 countries: two-thirds therefore managed without them. Despite some variation, most law texts specified restrictions related to legal criteria, enforcement mechanisms and safeguards. Restrictions on the person were often specified in separate tailored plans, and most regimes permitted indefinite renewals, which means that the duration of restrictions can be ascertained only in retrospect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120158_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      CTO law texts preclude scrutiny of overall restrictiveness, which might add to current uncertainties regarding the proportionality of CTOs and their role in balancing individuals\u2019 rights to both autonomy and care. The current policy drive towards community care should not automatically lead to new CTO regimes until their effectiveness and\n                      <jats:italic>de facto<\/jats:italic>\n                      restrictiveness are established.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2026.12015","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T07:45:36Z","timestamp":1781768736000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Availability and restrictiveness of community treatment orders across 33 European countries"],"prefix":"10.1192","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5842-2845","authenticated-orcid":false,"given":"Jorun","family":"Rugk\u00e5sa","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0331wat71","id-type":"ROR","asserted-by":"publisher"}],"name":"Akershus University Hospital"},{"id":[{"id":"https:\/\/ror.org\/04q12yn84","id-type":"ROR","asserted-by":"publisher"}],"name":"Oslo Metropolitan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah Oyine","family":"Aluh","sequence":"additional","affiliation":[{"name":"University of Lisbon"},{"name":"University of Nigeria Nsukka"},{"name":"University of Greater Manchester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Chihai","sequence":"additional","affiliation":[{"name":"State Medical and Pharmaceutical University Nicolae Testemitanu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren Fryd","family":"Birkeland","sequence":"additional","affiliation":[{"name":"University of Southern Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6635-9564","authenticated-orcid":false,"given":"Andreas","family":"Chatzittofis","sequence":"additional","affiliation":[{"name":"University of Cyprus"},{"name":"Ume\u00e5 University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"S2056472426120158_ref17","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2024.744"},{"key":"S2056472426120158_ref18","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-016-1304-6"},{"key":"S2056472426120158_ref28","volume-title":"Draft Mental Health Bill","year":"2022"},{"key":"S2056472426120158_ref6","volume-title":"Mental Health, Human Rights and legislation: Guidance and Practice","year":"2023"},{"key":"S2056472426120158_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(18)30382-1"},{"key":"S2056472426120158_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2016.12.022"},{"key":"S2056472426120158_ref14","doi-asserted-by":"publisher","DOI":"10.1017\/S2045796025000058"},{"key":"S2056472426120158_ref36","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijlp.2006.02.002"},{"key":"S2056472426120158_ref1","volume-title":"International Experiences of Using Community Treatment Orders","author":"Churchill","year":"2007"},{"key":"S2056472426120158_ref38","doi-asserted-by":"publisher","DOI":"10.1177\/00048674241246436"},{"key":"S2056472426120158_ref27","unstructured":"27 Ministry of Health and Elderly Affairs. Forslag til Lov om \u00e6ndring af lov om anvendelse af tvang i psykiatrien m.v., sundhedsloven og forskellige andre love. 2018\/1 LSF 164. [Proposal for an Act to Amend the Act on the Use of Coercion in Psychiatry, the Health Act, and Various Other Acts, 2018\/1 LSF 164.] Ministry of Health and Elderly Affairs, 2018 (https:\/\/www.retsinformation.dk\/eli\/ft\/201812L00164)."},{"key":"S2056472426120158_ref9","first-page":"111","article-title":"Community treatment orders in psychiatry: some ethical pitfalls","volume":"48","author":"Newton-Howes","year":"2014","journal-title":"Aust N Z J Psychiatry"},{"key":"S2056472426120158_ref15","first-page":"1","volume-title":"Coercion in Community Mental Health Care International Perspectives","author":"Rugk\u00e5sa","year":"2016"},{"key":"S2056472426120158_ref22","doi-asserted-by":"publisher","DOI":"10.3109\/01612840.2014.955933"},{"key":"S2056472426120158_ref26","volume-title":"The Provision of Community-Based Mental Health Care in Lithuania","author":"Wijker","year":"2022"},{"key":"S2056472426120158_ref29","unstructured":"29 The Norwegian Parliament. Avd. 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Bundesverfassungsgericht, 2024 (https:\/\/www.bundesverfassungsgericht.de\/SharedDocs\/Entscheidungen\/EN\/2024\/11\/ls20241126_1bvl000124en.html)."},{"key":"S2056472426120158_ref3","first-page":"356","volume-title":"Routledge Handbook of Mental Health Law","author":"Dawson","year":"2024"},{"key":"S2056472426120158_ref35","doi-asserted-by":"publisher","DOI":"10.1186\/s40878-023-00359-8"},{"key":"S2056472426120158_ref37","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-025-07161-z"},{"key":"S2056472426120158_ref8","first-page":"173","article-title":"The ethics of mandatory community treatment","volume":"31","author":"Muntez","year":"2003","journal-title":"J Am Academy Psychiatry Law"},{"key":"S2056472426120158_ref7","first-page":"384","volume-title":"Routledge Handbook of Mental Health Law","author":"Kelly","year":"2024"},{"key":"S2056472426120158_ref16","volume-title":"Community Treatment Orders: International Comparisons","author":"Dawson","year":"2005"},{"key":"S2056472426120158_ref31","volume-title":"Proposal for the Program to Improve Mental Health in Montenegro 2025\u20132026, with the Proposed Action Plan 2025\u20132026","year":"2025"},{"key":"S2056472426120158_ref20","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-035121"},{"key":"S2056472426120158_ref21","first-page":"40","article-title":"Coercion, risk and defensive practice in mental health","volume":"40","author":"Fisk","year":"2015","journal-title":"Manch Rev Law Crime Ethics"},{"key":"S2056472426120158_ref23","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-020-02501-7"}],"container-title":["BJPsych Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2056472426120158","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T07:45:42Z","timestamp":1781768742000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2056472426120158\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["S2056472426120158"],"URL":"https:\/\/doi.org\/10.1192\/bjo.2026.12015","relation":{},"ISSN":["2056-4724"],"issn-type":[{"value":"2056-4724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e166"}}