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Community Treatment Orders - superficially appealing

Posted Apr 21 2013 12:00am

It's really quite amazing that the British psychiatrist who was a champion of Community Treatment Orders, tested his own theory (published in The Lancet) and acknowledges that he was wrong. The evidence suggests CTOs don't work. The re-hospitalization percentage was the same for both groups (those force treated for a short time) and those on CTOs. In my opinion, the damage inflicted on the CTO patient in the form of stigma and loss of civil liberties is a big contributor to worse mental health outcomes over time.

From The Independent

In the study, researchers compared two separate groups of mentally ill patients to test if they experienced fewer hospital admissions. The first set of 166 patients were under CTOs, which can initially last for up to six months and can be renewed at the end of this period. Meanwhile, the other 167 participants tested had been placed on Section 17 leave, which is intended to be only a very short-term solution and can last a matter of days.
Their findings, published in The Lancet this month, revealed that 36 per cent of patients in both groups were readmitted to hospital within one year. There were no significant differences between the two groups in terms of the frequency and duration of admissions, the study found.
Both sets of patients were also remarkably similar in their social and medical outcomes.

Professor Burns added: "We were all a bit stunned by the result, but it was very clear data and we got a crystal clear result. So I've had to change my mind. I think sadly – because I've supported them for 20-odd years – the evidence is staring us in the face that CTOs don't work."
The Lancet study

The Lancet, Early Online Publication, 26 March 2013 doi:10.1016/S0140-6736(13)60107-5 This article can be found in the following collections:  Psychiatry  ( Schizophrenia ) Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial
Prof Tom Burns DSc, Jorun Rugås, PhD, Andrew Molodynski MBChB , John Dawson LLD, Ksenija Yeeles BSc , Maria Vazquez-Montes PhD, Merryn Voysey MBiostat, Julia Sinclair DPhil, Prof Stefan Priebe FRCPsych 


Interpretation In well coordinated mental health services the imposition of compulsory supervision does not reduce the rate of readmission of psychotic patients. We found no support in terms of any reduction in overall hospital admission to justify the significant curtailment of patients' personal liberty.
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