Rate of community treatment orders and readmission orders following reconfiguration of community mental health services

O’Donoghue, Brian; Brophy, Lisa; Owens, Nicholas; Rasic, Milana; McCullough, Belinda; Huang, Beatrice; Vine, Ruth; McKenna, Brian

doi:10.1177/1039856216629841

Cited by 10 publications

(8 citation statements)

References 11 publications

(11 reference statements)

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“…Nationally, 60 % of recalls ended in revocation during 2014/15 [16]; our rate of 68 % was slightly higher. There is a paucity of international studies of recall and revocation, but one small study from Victoria, Australia report a 62 % revocation level [25]. …”

Section: Discussionmentioning

confidence: 99%

Recall of patients on community treatment orders over three years in the OCTET CTO cohort

et al. 2016

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BackgroundRandomised studies consistently show that Community Treatment Orders (CTOs) do not have the intended effect of preventing relapse and readmissions of patients with severe and enduring mental illness. Critics suggest this in part can be explained by RCTs studying newly introduced CTO regimes and that patients therefore were not brought back to hospital for short-term observations (‘recall’) as frequently as intended. Our purpose was (i) to test the hypothesis that CTO practice as regards recall of patients to hospital in England and Wales was as rigorous under the OCTET trial period as in current routine use and (ii) to investigate the reasons for and outcomes of recalls and whether this changed over time.MethodThirty six-month observational prospective study of 198 patients in the OCTET Follow-up Study.ResultsForty percent of patients were recalled, 19 % more than once. This is in line with current national use. Deterioration in clinical condition was the most common reason for recalls (49 %), and 68 % of recalls resulted in revocation of the order (i.e., retention in hospital under compulsion). This pattern remained stable over time.ConclusionThe use of recall cannot explain why RCTs have not confirmed any benefits from CTOs, and their continued use should be reconsidered.Trial registrationThe OCTET Trial was retrospectively registered on 12 November 2009 (ISRCTN73110773)

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Section: Discussionmentioning

confidence: 99%

Recall of patients on community treatment orders over three years in the OCTET CTO cohort

et al. 2016

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“…There is, therefore, the paradoxical possibility of restricting a patient’s autonomy via a CTO with the therapeutic purpose of nurturing their autonomy. The effectiveness of CTOs in facilitating recovery has also been extensively reported on and some report that there is insufficient evidence for believing they are any better at improving quality of life than voluntary care (10–13).…”

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confidence: 99%

Trust and Community Treatment Orders

2019

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There are conflicting views about the benefits of community treatment orders (CTOs) for people with mental illness. While there is a significant literature on the coercive nature of CTOs, there is less on the impact that CTOs have upon trust. A recovery-oriented approach requires a trusting therapeutic relationship and the coercion inherent in the CTO process may make it difficult for trust to be built, nurtured, and sustained between workers and patients. Our aim was therefore to examine the role of trust within the CTO experience for mental health workers and patients on CTOs. Methods: We conducted a thematic discourse analysis of 8 in-depth interviews with people who were currently on a CTO and 10 interviews with multi-disciplinary mental health workers in Adelaide, Australia (total N = 18 interviews). The interviews were coded and analyzed with the assistance of a patient representative. The findings reveal the challenges and opportunities for trust within the coercive relationship of a CTO. Findings: We found that patients have diverse experiences of CTOs and that trust or mistrust played an import role in whether or not they found the CTO beneficial.

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“…Some rates are based on total populations, others on adults only and some are based on adults up to the age of 65. 3,14…”

Section: Discussionmentioning

confidence: 99%

“…Some rates are based on total populations, others on adults only and some are based on adults up to the age of 65. 3,14 Patients were middle aged (30-50 years) with a slight male predominance (56.4%). 4,6,17 The percentage of all involuntary in-patients who received an out-patient commitment order at discharge varied between 9.2 and 11.9% over the study years, which is about the same level as reported from England, 14 but lower than other jurisdictions.…”

Section: Use Of Out-patient Commitmentmentioning

confidence: 99%

“…The legal possibility of subjecting out-patients to mandatory care has steadily increased in recent decades, especially in North America, Oceania and Europe. [1][2][3][4] Norway authorised out-patient commitment as early as in 1961, when patients discharged with an out-patient commitment order could be recalled to in-patient care without any further formalities. In 1999, the Norwegian Mental Health Act was amended, authorising out-patient commitment without a prior in-patient period.…”

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confidence: 99%

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Out-patient commitment order use in Norway: incidence and prevalence rates, duration and use of mental health services from the Norwegian Outpatient Commitment Study

et al. 2019

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Background Norway authorised out-patient commitment in 1961, but there is a lack of representative and complete data on the use of out-patient commitment orders. Aims To establish the incidence and prevalence rates on the use of out-patient commitment in Norway, and how these vary across service areas. Further, to study variations in out-patient commitment across service areas, and use of in-patient services before and after implementation of out-patient commitment orders. Finally, to identify determinants for the duration of out-patient commitment orders and time to readmission. Method Retrospective case register study based on medical files of all patients with an out-patient commitment order in 2008–2012 in six catchment areas in Norway, covering one-third of the Norwegian population aged 18 years or more. For a subsample of patients, we recorded use of in-patient care 3 years before and after their first-ever out-patient commitment. Results Annual incidence varied between 20.7 and 28.4, and prevalence between 36.5 and 48.9, per 100 000 population aged 18 years or above. Rates differed significantly between catchment areas. Mean out-patient commitment duration was 727 days (s.d. = 889). Use of in-patient care decreased significantly in the 3 years after out-patient commitment compared with the 3 years before. Use of antipsychotic medication through the whole out-patient commitment period and fewer in-patient episodes in the 3 years before out-patient commitment predicted longer time to readmission. Conclusions Mechanisms behind the pronounced variations in use of out-patient commitment between sites call for further studies. Use of in-patient care was significantly reduced in the 3 years after a first-ever out-patient commitment order was made. Declaration of interest None.

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Rate of community treatment orders and readmission orders following reconfiguration of community mental health services

Abstract: Rates of CTOs and readmissions varied across services and further research is warranted to identify factors associated with these increased rates. Additionally, the very high rate of CTOs in the catchment areas warrants further examination.

Cited by 10 publications

References 11 publications

Recall of patients on community treatment orders over three years in the OCTET CTO cohort

Recall of patients on community treatment orders over three years in the OCTET CTO cohort

Trust and Community Treatment Orders

Out-patient commitment order use in Norway: incidence and prevalence rates, duration and use of mental health services from the Norwegian Outpatient Commitment Study

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