Community Treatment Orders: Profile of a Canadian Experience

O'Brien, Ann-Marie; Farrell, Susan

doi:10.1177/070674370505000106

Cited by 42 publications

(27 citation statements)

References 33 publications

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“…There was also no evidence for ''any effect of CTO on social functioning, arrests, homelessness, general mental state, psychopathology, quality of life, carer satisfaction, or perceived coercion.'' 2, p 179 Some small local studies, [26][27][28][29][30] all reporting improved patient outcomes, were excluded in Churchill et al's review given their naturalistic, retrospective design, combined with very small sample sizes (from 25-70 ). When repeating the search from those previous reviews to identify outcome studies published since 2013, 19 articles were identified, 9 of which reported on the outcomes described in Table 1 (6 UBAs, 1CBA, 1 epidemiological, and 1 meta-analysis).…”

Section: What Review Studies Findmentioning

confidence: 99%

Effectiveness of Community Treatment Orders: The International Evidence

Rugkåsa

2016

Can J Psychiatry

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Objective: Community treatment orders (CTOs) exist in more than 75 jurisdictions worldwide. This review outlines findings from the international literature on CTO effectiveness. Method: The article draws on 2 comprehensive systematic reviews of the literature published before 2013, then uses the same search terms to identify studies published between 2013 and 2015. The focus is on what the literature as a whole tells us about CTO effectiveness, with particular emphasis on the strength and weaknesses of different methodologies. Results:The results from more than 50 nonrandomized studies show mixed results. Some show benefits from CTOs while others show none on the most frequently reported outcomes of readmission, time in hospital, and community service use. Results from the 3 existing randomized controlled trials (RCTs) show no effect of CTOs on a wider range of outcome measures except that patients on CTOs are less likely than controls to be a victim of crime. Patients on CTOs are, however, likely to have their liberty restricted for significantly longer periods of time. Meta-analyses pooling patient data from RCTs and high quality nonrandomized studies also find no evidence of patient benefit, and systematic reviews come to the same conclusion. Conclusion: There is no evidence of patient benefit from current CTO outcome studies. This casts doubt over the usefulness and ethics of CTOs. To remove uncertainty, future research must be designed as RCTs. Abré géObjective : Les ordonnances de traitement en milieu communautaire (OTMC) existent dans plus de 75 administrations du monde entier. Cette revue présente les résultats de la littérature internationale sur l'efficacité des OTMC. Mé thode : L'article puise à deux revues systématiques complètes de la littérature publiée avant 2013, puis utilise les mêmes termes de recherche pour identifier les études publiées entre 2013 et 2015. L'accent est mis sur ce que la littérature dans son ensemble nous dit sur l'efficacité des OTMC, en insistant particulièrement sur les forces et faiblesses des différentes méthodologies.Ré sultats : Les résultats de plus de 50 études non randomisées étaient partagés. Certains montrent les avantages des OTMC alors que d'autres ne présentent aucun des résultats les plus fréquemment observés concernant: la réhospitalisation, le séjour à l'hôpital, et l'utilisation des services communautaires. Les résultats des trois essais randomisés contrô lés (ERC) existants n'indiquent aucun effet des OTMC sur ces mesures des résultats (ou une gamme plus vaste de mesures), excepté que les patients des OTMC sont moins susceptibles d'être victimes de criminalité. Les patients des OTMC sont toutefois susceptibles de se voir restreindre leur liberté pour des périodes de temps significativement plus longues. Les méta-analyses regroupant les données des patients des ERC, et les études non randomisées de grande qualité n'offrent pas non plus de preuves des avantages pour les patients, et les revues systématiques en viennent à la même conclusion.

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Section: What Review Studies Findmentioning

confidence: 99%

Effectiveness of Community Treatment Orders: The International Evidence

Rugkåsa

2016

Can J Psychiatry

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“…and, in practice, most CTOs are initiated from inpatient units (O'Brien & Farrell, 2005 to permit health information to be transferred between health care providers. Is it ethical to rely on implied consent if the person is receiving treatment involuntarily?…”

Section: Issues In Practicementioning

confidence: 99%

An international comparison of legal frameworks for supported and substitute decision-making in mental health services

Davidson

Brophy

Campbell

et al. 2016

International Journal of Law and Psychiatry

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“…Three of these studies focus primarily on hospital utilization rates as an outcome measurement of the effectiveness of CTOs (O'Brien and Farrell 2005;Frank et al 2005;Hunt et al 2007). Two studies focus on stakeholders' perceptions of CTOs (O'Reilly et al 2000, andO'Reilly et al 2006).…”

Section: Literature Reviewmentioning

confidence: 99%

“…Two studies focus on stakeholders' perceptions of CTOs (O'Reilly et al 2000, andO'Reilly et al 2006). O'Brien and Farrell (2005) was the first small sample study (n = 25). It focused on a single site with no cross region comparisons.…”

Section: Literature Reviewmentioning

confidence: 99%

Community Treatment Orders: Beyond Hospital Utilization Rates Examining the Association of Community Treatment Orders with Community Engagement and Supportive Housing

O'Brien

Farrell

Faulkner

2009

Community Ment Health J

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The purpose of this paper is to examine the association of community treatment orders (CTO) with community engagement and housing arrangements for one population of psychiatric patients in Ontario, Canada. Socio demographic characteristics and health service utilization information were collected for each patient placed on a CTO during a 3 year period. Information was collected for each of the 84 patients when a CTO was first issued and then updated to reflect both the patient's ongoing involvement with the legislation and related clinical outcomes. A significant increase in the number of community services and a shift to supportive housing arrangements was found for patients following issuance of a CTO.

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Community Treatment Orders: Profile of a Canadian Experience

Abstract: CTOs are effective tools for allowing patients to live in the least restrictive setting possible while they receive diverse services. They also effectively reduce rates and lengths of readmission to hospital.

Cited by 42 publications

References 33 publications

Effectiveness of Community Treatment Orders: The International Evidence

Effectiveness of Community Treatment Orders: The International Evidence

An international comparison of legal frameworks for supported and substitute decision-making in mental health services

Community Treatment Orders: Beyond Hospital Utilization Rates Examining the Association of Community Treatment Orders with Community Engagement and Supportive Housing

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