AIM: The presentation aims to critically discuss the dilemmas faced by a public sector psychiatrist based in Western Australia while placing a person on an involuntary community treatment order (CTO).

METHOD: Following an extensive review of literature of issues involved in placing mentally unwell persons on involuntary CTO, violating the individual’s personal autonomy and rights, a qualitative analysis (demographic background, clinical profile and issues/problems faced) of the most recent, chronological 15 CTOs issued by the presenter at the Fremantle Hospital, was carried out. The dilemma’s faced by the presenter – a psychiatrists working in the public mental health sector – was critically reviewed and discussed with a multidisciplinary team of mental health care professionals and few users of services and carers of the mentally ill.

RESULTS: Issues such as the rigour and nature of supervision of persons on CTOs, managing the contradictory issues during the obligatory requirement of presentation before the Mental Health Tribunal, challenges of educating patients about the need and probable benefits of CTO and timing of taking the individual off the CTO were dilemmas faced by psychiatrists.

CONCLUSION: Australia (including New Zealand) is a country with comparatively higher rate of use of CTOs for management of persons with mental disorders. A legal instrument such as a CTO – an order for involuntary treatment – can be creatively and constructively used for the overall benefit of patients and their families.