Editing Outpatient commitment (section)

==Implementation==
Discussions of "outpatient commitment" began in the psychiatry community in the 1980s following [[deinstitutionalization]], a trend that led to the widespread closure of public psychiatric hospitals and resulted in the discharge of large numbers of people with mental illness to the community. <ref>{{Cite web |title=Deinstitutionalization - Special Reports {{!}} The New Asylums {{!}} FRONTLINE {{!}} PBS |url=https://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html |access-date=2024-06-17 |website=www.pbs.org}}</ref>

===Europe===
====Denmark====
Denmark introduced outpatient commitment in 2010 with the ''Mental Health Act'' ({{langx|da|Lov om anvendelse af tvang i psykiatrien}}).<ref name=Riley2017/>

====Germany====
In Germany, CTOs were resumed in 2015<ref>{{cite web |title=Beschlussempfehlung und Bericht des Rechtsausschusses (6. Ausschuss) zu dem Gesetzentwurf der Fraktionen der CDU/CSU und FDP: Entwurf eines Gesetzes zur Regelung der betreuungsrechtlichen Einwilligung in eine ärztliche Zwangsmaßnahme |date=16 January 2013 |publisher=[[Bundestag|Deutscher Bundestag]] |url=https://dserver.bundestag.de/btd/17/120/1712086.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://dserver.bundestag.de/btd/17/120/1712086.pdf |archive-date=2022-10-09 |url-status=live |language=de}}</ref> (formerly only for [[forensic psychiatry]]<ref name=Steinert2014>{{cite journal |last1=Steinert |first1=Tilman |last2=Noorthoorn |first2=Eric O. |last3=Mulder |first3=Cornelis L. |date=24 September 2014 |title=The use of coercive interventions in mental health care in Germany and the Netherlands: A comparison of the developments in two neighboring countries |journal=Frontiers in Public Health |volume=2 |page=141 |pmid=25309893 |pmc=4173217 |doi=10.3389/fpubh.2014.00141 |doi-access=free }}</ref>).
Laws regarding implementations are distincts between lander.

====France====
The CTOs are renewed every month. They were introduced under [[Nicolas Sarkozy]] presidency.<ref>{{Cite web | url=https://www.collectifpsychiatrie.fr/?p=3236 | title=> la loi du 5 juillet 2011 : Vers un contrôle social psychiatrique ? &#124; Quelle hospitalité pour la folie ? | date=22 February 2012 }}</ref> Persons committed are registered on a national file accessible by police, even if they are not suspected of breaking the law.<ref>{{Cite web | url=https://www.santementale.fr/2020/03/le-conseil-d-etat-rejette-les-recours-contre-le-decret-hopsyweb/ | title=Le Conseil d'Etat valide le fichier Hopsyweb | date=30 March 2020 }}</ref>

====The Netherlands====
{{As of|2014|post=,}} Dutch law provides for community treatment orders, and an individual who does not comply with the terms of their CTO may be subject to immediate involuntary commitment.<ref name=Steinert2014/>

====Norway====
When Norway introduced outpatient commitment in the 1961 ''Mental Health Act'', it could only be mandated for individuals who had previously been admitted for inpatient treatment.<ref name=Riley2017>{{cite journal |last1=Riley |first1=Henriette |last2=Straume |first2=Bjørn |last3=Høyer |first3=Georg |date=2 May 2017 |title=Patients on outpatient commitment orders in Northern Norway |journal=BMC Psychiatry |volume=17 |issue=1 |page=157 |doi=10.1186/s12888-017-1331-1 |doi-access=free |pmid=28464805 |pmc=5414164 }}<!--Note: Although this is a primary source, only information from the "Background" section is used.--></ref> Revisions in 1999 and 2006 provided for outpatient commitment without previous inpatient treatment, but this provision is seldom used.<ref name=Riley2017/>

====Sweden====
In Sweden, the ''Compulsory Psychiatric Care Act'' ({{langx|sv|Lag om psykiatrisk tvångsvård}}) provides for an administrative court to mandate psychiatric treatment to prevent harm to the individual or others.<ref name=Reitan2016>{{cite journal |last=Reitan |first=Therese |date=March–April 2016 |title=Commitment without confinement: Outpatient compulsory care for substance abuse, and severe mental disorder in Sweden |journal=International Journal of Law and Psychiatry |volume=45 |pages=60–69 |doi=10.1016/j.ijlp.2016.02.011 |doi-access=free |pmid=26912456 }}</ref>{{rp|61}} The law was created in 1991 and revised in 2008.<ref name=Reitan2016/>{{rp|62}}

====England and Wales====
Changes in service provision and amendments to the Mental Health Act in England and Wales have increased the scope for compulsion in the community.<ref>{{Cite journal|last1=Molodynski|first1=A.|last2=Rugkasa|first2=J.|last3=Burns|first3=T.|date=2010-05-25|title=Coercion and compulsion in community mental health care|journal=British Medical Bulletin|volume=95|issue=1|pages=105–119|doi=10.1093/bmb/ldq015|pmid=20501486|issn=0007-1420|doi-access=free}}</ref> The [[Mental Health Act 2007]] introduced community treatment orders (CTOs).<ref name=MindUK/> CTOs are legally defined as a form of outpatient leave for individuals detained under section 3 of the Mental Health Act.<ref>{{cite web|last=|first=|date=|title=Mental Health Act 1983: Section 17A|url=http://www.legislation.gov.uk/ukpga/1983/20/section/17A|archive-url=|archive-date=|access-date=|website=}}</ref> As such, only members of the medical community are involved in issuing a CTO, though both the section 3 detention underlying the CTO and the CTO itself can be appealed to the [[Mental Health Tribunal]] where a panel consisting of medical doctors and a judge will make a decision.The legislation in the UK specifically allows CTOs to be issued after a single admission to hospital for treatment. However, the [[Royal College of Psychiatrists]] suggested limiting CTOs to patients with a history of noncompliance and hospitalization, when it reviewed the current mental health legislation.{{efn|name=rspych| "The remit of CTOs should be limited to ensure they are only used when most beneficial. The Review should consider amending the criteria to reflect a history of non-compliance with treatment leading to subsequent compulsory admission(s) within a defined timeframe."<ref>{{cite web|url=https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/policy/policy-rcpsych-mha-review-submission-2018.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/policy/policy-rcpsych-mha-review-submission-2018.pdf |archive-date=2022-10-09 |url-status=live|title=Review of the Mental Health Act 1983 The Royal College of Psychiatrists' submission of evidence}}</ref>}}

John Mayer Chamberlain argues that this legislation was triggered by the [[Killing of Jonathan Zito]] by an individual who had interactions with mental health services prior this event, which led the then conservative government to argue for CTOs.<ref>{{Cite book |last=Chamberlain |first=John Martyn |url=https://books.google.com/books?id=Hnn4CgAAQBAJ |title=Medicine, Risk, Discourse and Power |date=2015-11-19 |publisher=Routledge |isbn=978-1-317-33196-4 |language=en}}</ref>{{Rp|127}}

A review of patient data in London found that the average duration of a CTO in the UK was 3 years.<ref name="Barkhuizen Cullen Shetty Pritchard 2016 p.">{{cite journal | last1=Barkhuizen | first1=Wikus | last2=Cullen | first2=Alexis E | last3=Shetty | first3=Hitesh | last4=Pritchard | first4=Megan | last5=Stewart | first5=Robert | last6=McGuire | first6=Philip | last7=Patel | first7=Rashmi | title=Community treatment orders and associations with readmission rates and duration of psychiatric hospital admission: a controlled electronic case register study | journal=BMJ Open | volume=10 | issue=3 | date=2016-07-31 | pages=e035121 | pmid=32139493 | doi=10.1136/bmjopen-2019-035121 | pmc=7059496 | doi-access=free }}</ref> Black people in the UK are more than ten times as likely to be under a CTO as white people.<ref name=":0">{{Cite web|last=|first=|date=|title=Mental Health Act White Paper 2021|url=https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/951398/mental-health-act-white-paper-web-accessible.pdf|archive-url=|archive-date=|access-date=|website=}}</ref>{{Rp|13}} Concerns have been raised about the inability of Independent mental health advocates (IHMAs) to provide services to those under CTOs, since IMHAs cannot make contact with service users under CTOs and case workers could act as gatekeepers not providing referrals.<ref>{{Cite journal |last1=Weller |first1=Penelope |last2=Alvarez-Vasquez |first2=Susan |last3=Dale |first3=Matthew |last4=Hill |first4=Nicholas |last5=Johnson |first5=Brendan |last6=Martin |first6=Jennifer |last7=Maylea |first7=Chris |last8=Thomas |first8=Stuart |date=2019-09-01 |title=The need for independent advocacy for people subject to mental health community treatment orders |url=https://www.sciencedirect.com/science/article/pii/S0160252718301845 |journal=International Journal of Law and Psychiatry |language=en |volume=66 |pages=101452 |doi=10.1016/j.ijlp.2019.101452 |pmid=31706387 |s2cid=196580245 |issn=0160-2527|url-access=subscription }}</ref>{{Rp|page=6|quote=There was a concern raised over the course of the evaluation that where case managers acted as "gatekeepers", few alternatives exist for consumers to learn about and access the IMHA service.}}

In a 2021 paper reviewing the mental health act, the UK government proposed a new form of indefinite outpatient commitment allowing for deprivation of liberties an continuous supervision termed supervised discharge. This discharge would be reviewed yearly, and only apply to individuals who would not benefit from treatment in a hospital setting and would be based on risk.<ref name=":0" />{{Rp|77}} Further, this legislation would only apply to restricted patients who have been diverted to the mental health care system from courts.<ref>{{Cite web|last=|first=|date=|title=Restricted Patients 2018 - Ministry of Justice Statistics Bulletin|url=https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/796926/restricted-patients-statistical-bulletin-2018.pdf|archive-url=|archive-date=|access-date=|website=}}</ref>

====Scotland====

Scotland has a different community commitment regime from England and Wales introduced in the 2003 Mental Health Act.<ref>{{cite web|url=http://www.legislation.gov.uk/asp/2003/13/part/7|title=Mental Health Act (Scotland) 2003: Pat 7 }}</ref> There is ongoing debate in the UK on the place of coercion and compulsion in community mental health care.

====Luxembourg====
Patients may be recalled if they don't abide to conditions on residence or medical supervision decided by a psychiatrist on discharge for 3 months after having been released from an involuntary commitment.<ref>{{Cite web |title=Law of 10th December 2009 relating to hospitalization on people with mental conditions without consent (Loi du 10 décembre 2009 a) relative à l'hospitalisation sans leur consentement de personnes atteintes de troubles mentaux) |url=https://legilux.public.lu/eli/etat/leg/loi/2009/12/10/n1/jo |access-date=2022-03-20 |website=legilux.public.lu}}</ref>{{Rp|page=5.27}}

===North America===
In the last decade of the 20th century and the first of the 21st, "outpatient commitment" [[laws]] were passed in a number of [[U.S. state]]s and jurisdictions in [[Canada]].{{citation needed|date=October 2017}}

====Canada====
[[File:Canada CTOs.svg|thumb|alt=Map: implementation of community treatment orders in Canadian provinces and territories |{{abbr|CTO|community treatment order}} implementation in Canada (2013)]]
In the mid-1990s, [[Saskatchewan]] became the first Canadian province to implement community treatment orders, and [[Ontario]] followed in 2000.<ref name=Kisely2016>{{cite journal |last=Kisely |first=Steve |date=January 2016 |title=Canadian Studies on the Effectiveness of Community Treatment Orders |journal=Canadian Journal of Psychiatry |volume=61 |issue=1 |pages=7–14 |pmid=27582448 |pmc=4756603 |doi=10.1177/0706743715620414 |doi-access=free }}</ref> {{As of|2016|1|post=,}} [[New Brunswick]] was the only province without legislation that provided for either CTOs or extended leave.<ref name=Kisely2016/>
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====United States====
[[File:Map of USA with state names AOT.svg|thumb|{{abbr|AOT|assisted outpatient treatment}} implementation in the United States (2013)]]
{{As of|2010|alt=By the end of 2010,}} 44 U.S. states had enacted some version of an outpatient commitment law. In some cases, passage of the laws followed widely publicized tragedies, such as the murders of [[Laura's Law|Laura Wilcox]] and [[Kendra's Law|Kendra Webdale]].<ref>{{Cite web|url=https://www.sfgate.com/opinion/openforum/article/Laura-s-Law-an-opportunity-to-improve-life-3181356.php|title=Laura's Law - an opportunity to improve life|last1=Hanly|first1=Elizabeth|last2=Biasotti|first2=Michael C.|date=2010-07-19|website=SFGate|access-date=2020-02-03}}</ref><ref>{{Cite web|url=https://www.aei.org/articles/sane-mental-health-laws/|title=Sane Mental Health Laws?|website=American Enterprise Institute - AEI|language=en-US|access-date=2020-02-03}}</ref>
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===Oceania===
Australia and New Zealand introduced community treatment orders in the 1980s and 1990s.<ref name=Rugkasa2016>{{cite journal |last1=Rugkåsa |first1=Jorun |date=January 2016 |title=Effectiveness of Community Treatment Orders: The International Evidence |journal=Canadian Journal of Psychiatry |volume=61 |issue=1 |pages=15–24 |pmid=27582449 |pmc=4756604 |doi=10.1177/0706743715620415 |doi-access=free }}</ref>

====Australia====
In the Australian state of [[Victoria (Australia)|Victoria]], community treatment orders last for a maximum of twelve months<ref>{{Cite web|url=https://www.legalaid.vic.gov.au/find-legal-answers/mental-health-and-your-rights/compulsory-treatment-orders|title=Compulsory treatment orders|last=Askew|first=Maddy|date=2012-10-15|website=Victoria Legal Aid|language=en-AU|access-date=2020-02-03}}</ref> but can be renewed after review by a tribunal.{{citation needed|date=October 2017}}