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What does being on a community treatment orders entail? A 3-year follow-up of the OCTET CTO cohort

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Community Treatment Orders lack evidence of effectiveness. Very little is known about how they are used in practice and over time in terms of what it obliges patients to do and the judicial threshold for remaining on an order.

Aims

To investigate CTO implementation in England in terms of the use of specified conditions, and judicial hearings; whether these change over time, and; the level of continued coercion.

Method

36-month observational prospective study of patients on CTO in the OCTET follow-up study.

Results

The number of CTO conditions remained stable over time but consolidated around medication adherence and remaining in contact with services. Ten percent of Mental Health Tribunal Hearings and only 1 percent of Hospital Managers Hearings resulted in discharge. Twenty-seven percent of patients experienced more than one CTO episode and eighteen percent remained under compulsion until the end of follow-up.

Conclusions

CTOs seem to be used primarily to oblige patients to take medication and stay in contact with services. There is agreement between clinical and legal judgements about their appropriateness and threshold for use. A pattern of continuous coercion for a significant group of patients raises concerns. If CTOs are to be continued to be imposed, their use should be carefully monitored with further cohort studies with long-term follow-up.

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Acknowledgements

This article presents independent research funded by the National Institute of Health Research (Program Grant for Applied Research, Grant No. RP-PG-0606-1006). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. We are grateful to the OCTET researchers: Caroline Bennett, Kiki Burns, Krysia Canvin, Alexandra Forrest, Lindsey Johnston, Naomi Lewis, Sarah Masson, Andrew Molodynski, Lucy Murray, Helen Nightingale, Riti Patel, Stephen Puntis, Lisa Russell, Aonghus Ryan, Tanya Smith, Anna Sulman, Lucinda Turnpenny, Amy Mitchell, Maria Vazquez Montes, Francis Vergunst, Claire Visser, and Sue Woods-Ganz.

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Authors and Affiliations

  1. Health Services Research Unit, Akershus University Hospital, 1478, Lørenskog, Norway

    Jorun Rugkåsa

  2. Department of Psychiatry, University of Oxford, Oxford, UK

    Jorun Rugkåsa, Ksenija Yeeles & Tom Burns

  3. Department of Primary Care, University of Oxford, Oxford, UK

    Constantinos Koshiaris

Authors
  1. Jorun Rugkåsa
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  2. Ksenija Yeeles
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  3. Constantinos Koshiaris
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  4. Tom Burns
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Correspondence to Jorun Rugkåsa.

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Jorun Rugkåsa, Ksenija Yeeles are joint first authors.

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Rugkåsa, J., Yeeles, K., Koshiaris, C. et al. What does being on a community treatment orders entail? A 3-year follow-up of the OCTET CTO cohort. Soc Psychiatry Psychiatr Epidemiol 52, 465–472 (2017). https://doi.org/10.1007/s00127-016-1304-6

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  • DOI: https://doi.org/10.1007/s00127-016-1304-6

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