Ten Years of Community Treatment Orders in Western Switzerland: an Update

Abstract

Community treatment orders (CTOs) are legal procedures that authorise compulsory community mental health care for people with severe mental disorders. Since their introduction in Switzerland in 2013, the Swiss Canton of Vaud (846'300 inhabitants) has been engaged in the monitoring of CTOs. This study describes the use of this measure in the Canton of Vaud over the 10 years since its introduction and examines the profile of people undergoing CTOs during this period, the form that these measures took and the factors associated with their duration and outcome. Between 2013 and 2022, 530 CTOs have been ordered. As their incidence remained low and fluctuated between 5 and 10 CTOs per 100'000 inhabitants, their prevalence rose from 5 to 25 per 100'000 inhabitants. The profile of people placed under CTOs was comparable to that observed in other studies. The measures concerned mainly Swiss male in their forties, single or divorced/separated, living independently and under legal guardianship. The main diagnosis was schizophrenia, schizotypal or delusional disorders. On the 31st of December 2022, 329 CTOs (62.1%) had been discharged. Their average duration was slightly more than two years. Among the 329 CTOs discharged at the 31st of December 2022, five groups were identified according to the reasons for discharge: CTO success (38.7%), breached conditions with (24.0%) and without involuntary hospitalisation (11.5%), death of the patient (13.0%) and other reasons for discharge (12.8%). Prototypical situations for each group were identified.

Keywords: Bayesian model; Coercion; Community treatment order; Epidemiology; Involuntary outpatient treatment; Outpatient commitment.