The Community Treatment Order (CTO) Programme has been in place in several countries and encompasses the legislative requirement of a group of psychiatric patients to receive psychiatric treatment.

The Institute of Mental Health (IMH),Singapore has implemented a pilot supervision programme (PSP) that contains elements of the CTO programme (but without the requirement for legislative changes).

The objective of PSP is to engage patients with serious mental disorders, such as schizophrenia, delusional disorder, bipolar disorder (as per the Diagnostic and Statistical Manual of Mental Disorders IV criteria) to continue to receive treatment while living in the community, the least restrictive environment.

This paper focuses on the implementation of Phase 1 of PSP. Phase 1 which cover a period of one year focuses on ‘high-risk‘ patients who suffer from a major psychiatric disorder and had 3 and more inpatient admissions over the past 1 year. They are then divided into 3 groups (70 each):

1. 1) Group 1: Receiving standard community mental health treatment (monthly visit) and service is chargeable.

2. 2) Group 2: Same as Group 1 but service is pro-bono.

3. 3) Group 3: Receiving intensive community mental health treatment (weekly visit) and service is pro-bono.

In addition, patients in Group 2 and 3 will also receive incentives such as welfare voucher.

The results of Phase 1 will provide a better understanding of the patient's motivation and/or compliance for treatment and forms the test bed for Phase 2 which will include psychiatric patients with significant Axis II diagnoses.