Outpatient Committal: “Politics and Psychiatry in a Culture of Fear”


Psychiatrists’ use of community treatment orders (or outpatient committal) in the UK is already ten times more frequent than was originally envisioned, writes Manchester Metropolitan University’s Ken McLaughlin in Politics.co.uk. This is evidence, he argues, that the whole idea of community treatment orders is misguided.

“(P)sychiatric practice is still all too often directed not by advances in mental health care but by the political and cultural concerns of the day,” writes McLaughlin. “The use and abuse of Community Treatment Orders (CTOs) is but one of the more recent manifestations of this process. They are reflective of a wider culture of fear and risk aversion, of a political establishment increasingly concerned with the micromanagement of community life, a process which also affects professionals who increasingly work in a risk-averse manner.”

“It was initially thought that CTOs would mainly be used on patients with several psychiatric admissions, the so-called ‘revolving door’ patient phenomenon, whereby someone was admitted to hospital, got better with medication, was discharged, stopped taking the medication, relapsed, was readmitted to hospital and so on. Irrespective of this, a history of non-compliance is not necessary for a CTO to be imposed; it can be applied to a patient after a first compulsory admission for treatment provided the necessary criteria are met.”

McLaughlin says that government envisaged 350-450 CTOs would be issued in England and Wales in the first year that the powers came in to force. “However, the number far exceeded the government’s and its advisers’ expectations. In the first five months in which professionals were able to issue them, November 2008 to March 2009, there were 2,134 issued in England alone.” In 2012, writes McLaughlin, there were 4,764 people subject to such orders – many following their first admission to a psychiatric hospital.

Community Treatment Orders: Politics and psychiatry in a culture of fear
(Politics.co.uk, October 7, 2014)


  1. This suggests that English psychiatry attracts people with sociopathic tendencies. As any rape councillor will admit, rape is an assault of power and control and not sex. Violating people by inducing distress and despair through drugs and disrespect must give these psychiatrists a certain “fix” of joy.

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  2. If someone could only compile an updated list of all the names of all the psychiatrists in the world with their home address’s and phone numbers all constantly updated and with a list of the psychiatrists who were ordering these CTO ‘s they could be called up for a friendly conversation or we could drop by maybe as unannounced lunch guests to discuss mutual concerns. I just happened to be in the neighborhood kind of thing. I brought you a a latte from Starbucks.

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  3. How often do we see this. “we need powers to deal with a small group of people who are falling through the cracks”. Powers are given in the false belief that those given the powers will not abuse them, and then hey presto, the 60 people who the powers were given to deal with turns into 6000.

    It was initially thought….. no it wasn’t but it never got discussed. The “stated aims” were false, and the “intended consequences” have now been realised.

    Having been threatened with one of these CTO’s they are nothing more than a stick for a psychiatrist to beat a person into submission with.

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