Sir: Two recent articles (Psychiatric Bulletin, November 1999, 23, 644-646 and Psychiatric Bulletin, November 1999, 23, 647-648) continue the debate surrounding the proposed introduction of Community Treatment Orders (CTOs).Having experience in the use of CTOs in Victoria, Australia it is our contention that a CTO does not confer any advantage to the patient in comparison with a comprehensive community care. Indeed, we observed that their use frequently served to alienate patients from mental health services.

In reviewing CTO usage McIvor (Reference McIvor1998) highlights the paucity of research in this area despite their widespread implementation in Australia and New Zealand and suggests the need for controlled trials in order to justify their continued use. Burns poses the question, ‘is there a group of patients who are poorly served by the present legislation who are currently repeatedly subject to compulsory admission and whose welfare would be better served by a CTO?’. In our endeavour to practise evidence-based psychiatry surely the question must be, ‘Can a patient be subject to a CTO in the absence of proven efficacy?’.