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Conclusion The state of Victoria has been at the forefront of the move away from institutional to community based mental health practice. CTO's have been pivotal to this community focused model of service delivery. CTO's were readily adopted in Victoria twenty years ago with little extensive debate, and to date, there has been little open discussion about their actual value. This failure to examine their efficacy is due to a variety of reasons, which are outlined in the presentation. In the main, though, service managers and budget holders have been blinded to clinical and ethical issues that CTO's bring up because they assist services to manage the pressure on resources while, at the same time, they create an illusion of less restrictive care. This presentation highlights the various ways that clinical care has become cruder and less humane since the introduction of CTO's. These would seem to outweigh any benefits that are noted in specific examples and in the limited studies available. from WPA Thematic Conference. Coercive Treatment in Psychiatry: A Comprehensive Review Dresden, Germany. 6–8 June 2007

Community Treatment Orders (CTO's): a clinico-ethical perspective from Melbourne, Australia