The use of community treatment orders in competent patients is not justified

Newton‐Howes, Giles; Ryan, Christopher

doi:10.1192/bjp.bp.116.193920

Cited by 20 publications

(16 citation statements)

References 6 publications

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“…12,13 Such concern has come to particular prominence in recent years with the advent of the United Nations Convention on the Rights of Persons with Disabilities. 14,15 This disquiet around coercion has been heightened by conflicting research evidence about the effectiveness of CTOs. 16 Although some studies have found positive outcomes for patients, others have not.…”

Section: Community Treatment Orders: a Global Phenomenonmentioning

confidence: 99%

“…Time_Group Re-admission Censored CTO Censored, censorship status (0 = not censored, 1 = censored); CTO, CTO status (0 = control group patient, 1 = treatment group patient); Re-admission, re-admission status (0 = not re-admitted, 1 = re-admitted); Time_Group, time to re-admission or censorship in 90-day periods for the 4-year study period (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Appendixmentioning

confidence: 99%

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Use of community treatment orders and their outcomes: an observational study

Weich

Duncan

Twigg

et al. 2020

Health Serv Deliv Res

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Background Community treatment orders are widely used in England. It is unclear whether their use varies between patients, places and services, or if they are associated with better patient outcomes. Objectives To examine variation in the use of community treatment orders and their associations with patient outcomes and health-care costs. Design Secondary analysis using multilevel statistical modelling. Setting England, including 61 NHS mental health provider trusts. Participants A total of 69,832 patients eligible to be subject to a community treatment order. Main outcome measures Use of community treatment orders and time subject to community treatment order; re-admission and total time in hospital after the start of a community treatment order; and mortality. Data sources The primary data source was the Mental Health Services Data Set. Mental Health Services Data Set data were linked to mortality records and local area deprivation statistics for England. Results There was significant variation in community treatment order use between patients, provider trusts and local areas. Most variation arose from substantially different practice in a small number of providers. Community treatment order patients were more likely to be in the ‘severe psychotic’ care cluster grouping, male or black. There was also significant variation between service providers and local areas in the time patients remained on community treatment orders. Although slightly more community treatment order patients were re-admitted than non-community treatment order patients during the study period (36.9% vs. 35.6%), there was no significant difference in time to first re-admission (around 32 months on average for both). There was some evidence that the rate of re-admission differed between community treatment order and non-community treatment order patients according to care cluster grouping. Community treatment order patients spent 7.5 days longer, on average, in admission than non-community treatment order patients over the study period. This difference remained when other patient and local area characteristics were taken into account. There was no evidence of significant variation between service providers in the effect of community treatment order on total time in admission. Community treatment order patients were less likely to die than non-community treatment order patients, after taking account of other patient and local area characteristics (odds ratio 0.69, 95% credible interval 0.60 to 0.81). Limitations Confounding by indication and potential bias arising from missing data within the Mental Health Services Data Set. Data quality issues precluded inclusion of patients who were subject to community treatment orders more than once. Conclusions Community treatment order use varied between patients, provider trusts and local areas. Community treatment order use was not associated with shorter time to re-admission or reduced time in hospital to a statistically significant degree. We found no evidence that the effectiveness of community treatment orders varied to a significant degree between provider trusts, nor that community treatment orders were associated with reduced mental health treatment costs. Our findings support the view that community treatment orders in England are not effective in reducing future admissions or time spent in hospital. We provide preliminary evidence of an association between community treatment order use and reduced rate of death. Future work These findings need to be replicated among patients who are subject to community treatment order more than once. The association between community treatment order use and reduced mortality requires further investigation. Study registration The study was approved by the University of Warwick’s Biomedical and Scientific Research Ethics Committee (REGO-2015-1623). Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.

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Section: Community Treatment Orders: a Global Phenomenonmentioning

confidence: 99%

Section: Appendixmentioning

confidence: 99%

Use of community treatment orders and their outcomes: an observational study

Weich

Duncan

Twigg

et al. 2020

Health Serv Deliv Res

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“…However, competent patients are not necessarily good candidates for a CTO. Patients with DMC have adequate insight to opt for voluntary community treatment without a CTO (Newton-Howes & Ryan, 2017). However, it is worth noting that while a patient's DMC puts them in a better position, insight is not necessarily connected with treatment adherence, especially if the patient has a history of high-risk behaviour or has a severe relapse profile (Dawson & Mullen, 2008).…”

Section: Factors That Influence Outcomes Of Ctosmentioning

confidence: 99%

Community treatment orders: international perspective

Mikellides

Stefani²,

Tantele

2019

BJPsych Int.

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The use of community treatment orders (CTOs) is available in more than 70 jurisdictions around the world. Although CTOs are used extensively, their effectiveness remains doubtful. We comment on the existing evidence and focus on components that influence the outcomes of CTOs internationally. It is essential to identify factors that affect the delivery of CTOs, and mixed methodologies may improve our understanding regarding their efficiency.

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“…The need for support may still be high and services like intensive case management (ICM) or assertive community treatment (ACT) may have to be put in place (15). However, compulsory community treatment, which in the UK or the US often combines with ICM or ACT (16) would not be consistent with the principle of Article 12 of the CRPD.…”

Section: Psychosismentioning

confidence: 99%

Supported Decision Making in the Prevention of Compulsory Interventions in Mental Health Care

Zinkler¹

2019

Front. Psychiatry

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The use of community treatment orders in competent patients is not justified

Cited by 20 publications

References 6 publications

Use of community treatment orders and their outcomes: an observational study

Use of community treatment orders and their outcomes: an observational study

Community treatment orders: international perspective

Supported Decision Making in the Prevention of Compulsory Interventions in Mental Health Care

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