Community treatment orders: ethical practice in an era of magical thinking.

Résumé

With the passage of legislation in June 2000, coercive measures in the form of community treatment orders (CTOs) have become part of the community mental health landscape in Ontario. Given that community practitioners place a high value upon their ability to create voluntary and egalitarian partnerships with clients, the question of whether ethical practice is possible under conditions of legislated coercion is relevant. Based upon a review of the pro and con arguments that preceded CTO legislation, followed by an examination of available research on effectiveness, this paper suggests that forms of magical thinking have been at work on both sides of the CTO debate. A broader definition of coercion is proposed--one that envelopes both overt and covert forms. Finally, the author offers an approach to ethical practice which is based on the use of transformative power rather than coercive power, and which includes a 3-step strategy (using liberation tactics, proactive contracting, and procedural justice).