The harms and benefits of forced mental health treatment

The research examined the effectiveness of Community Treatment Orders, known as Treatment Authorities in Queensland, which are legal orders authorising the compulsory care and treatment, including the administration of medication, of a person with mental illness living in the community.

Australia has some of the highest rates in the world for using these orders.

Professor Steve Kisely from UQ's Medical School said researchers analysed Queensland data to determine how effective these orders were for conditions including schizophrenia, addiction, as well as mood, personality, and anxiety disorders.

“We found these orders may reduce hospital admissions for people with psychoses which cause hallucinations and delusional thinking, but not other conditions,” he said.

“That’s concerning because the use of these treatment orders is increasing, despite limited evidence they work.

“There are also concerning trends around their use for people from culturally or linguistically diverse backgrounds and First Nations peoples.

“People whose first language was not English were three times more likely to be placed on these orders, which raises questions about equity and cultural sensitivity in mental health care.”

The study examined hospital data from more than 32,000 Queenslanders, a third of whom had been placed on a treatment order between 2019 and 2022.

This study is part of a three-year project exploring the impact of Community Treatment Orders across four states of Australia – New South Wales, Queensland, South Australia and Victoria.

In another study, researchers found large discrepancies in the number of orders made across local health areas within different states.

“We examined data of more than 402,000 people who had been in contact with mental health services, and the number of people on Community Treatment Orders found an 18-fold difference in the rate of use across different health areas, which is a huge discrepancy.

“If health professionals are using these orders, then we need to have clearer guidance on how these are affecting patients.

“It’s also important to consider human rights and freedom in this discussion because while there is a necessity for compulsory treatment to a certain extent, we need to know the risks and benefits for patients.”

Professor Kisely will explore these issues in the next phase of the research.

“We know from previous studies that legal orders can be beneficial, but some patients have reported being forced into treatment made them feel resentful and disempowered.

“The harms and benefits of these orders are under-researched, and this will be a continued focus for our research team.

Professor Kisely hopes this Queensland research will better inform doctors and health professionals and help authorities move towards a consistent national approach.

The research has been published in The British Journal of Psychiatry.