Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial

Abstract

SummaryBackground Compulsory supervision outside hospital has been developed internationally for the treatment of mentally ill people following widespread deinstitutionalisation but its effi cacy has not yet been proven. Community treatment orders (CTOs) for psychiatric patients became available in England and Wales in 2008. We tested whether CTOs reduce admissions compared with use of Section 17 leave when patients in both groups receive equivalent levels of clinical contact but diff erent lengths of compulsory supervision.

Changes in determinants of compulsory community treatment over 11 years. A population-based analysis of linked mental health databases

“…For instance, some authors report reductions in readmissions and bed-days (Geller et al, 1998;Sensky et al, 1991;Segal et al, 2009;Kisely et al, 2013) while others do not (Vaughan et al, 2000;Preston et al, 2002;Kisely et al, 2004;Burns et al, 2013). Where studies were of administrative data, for example, it is possible that there were differences between studies in terms of characteristics for which it was not possible to obtain data and that these, in turn, might have contributed to the discrepancies in findings.…”

“…Another possibility, therefore, is that these variations in outcomes may be due to differences in design rather than in the patients placed on the orders. In general, the better the control of confounding, whether this is through randomisation or other means, the less likely it is that CTOs reduce readmissions or bed-days (Steadman et al, 2001;Swartz et al, 1999;Burns et al, 2013;Kisely et al, 2004).…”

Community treatment orders should be introduced in the Republic of Ireland

“…By 2014 a further 18 studies had been added (Maughan et al 2014) but only one of these was a RCT. OCTET (Oxford Community Treatment order Evaluation Trial) was a pragmatic RCT conducted across over 30 Trusts in England in clinical conditions likely to mirror those in the Irish Republic (Burns et al 2013). Like the two RCTs before it, OCTET found no benefits from CTOs in the primary outcome of reducing rate of rehospitalisation over the 1 year follow-up, nor in any other of the hospitalisation outcomes (delay, duration, etc.…”

Policies, guideline implementation and practice change – how can the process be understood?

“…In order to better understand the overall picture of a changing mental health care sector we need highquality efficacy research using randomised controlled trials such as those so brilliantly performed in the UK on the one hand (Burns et al 2013;Killaspy et al 2015) because that type of research can guide us and provide the building blocks in moving forward in intervention research. However, we also need large-scale social, political and economic science studies of complex health care systems and of how they achieve reform and innovation in 'real world' settings.…”