Social Psychiatry and Psychiatric Epidemiology

, Volume 52, Issue 11, pp 1375–1384 | Cite as

Community treatment orders and social outcomes for patients with psychosis: a 48-month follow-up study

  • Francis VergunstEmail author
  • Jorun Rugkåsa
  • Constantinos Koshiaris
  • Judit Simon
  • Tom Burns
Original Paper



Community treatment orders (CTOs) are widely used internationally despite a lack of evidence supporting their effectiveness. Most effectiveness studies are relatively short (12-months or less) and focus on clinical symptoms and service data, while a little attention is given to patients’ social outcomes and broader welfare. We tested the association between the duration of CTO intervention and patients’ long-term social outcomes.


A sub-sample (n = 114) of community-based patients from the Oxford Community Treatment Order Evaluation Trial (OCTET) were interviewed 48 months after randomisation. Multivariate regression models were used to examine the association between the duration of the CTO intervention and social outcomes as measured by the social network schedule, Objective Social Outcomes Index, Euro-Qol EQ-5D-3L (EQ-5D), and Oxford Capabilities Questionnaire for Mental Health.


No significant association was found between the duration of CTO intervention and social network size (IRR = 0.996, p = .63), objective social outcomes (B = −0.003, p = .77), health-related quality of life (B = 0.001, p = .77), and capabilities (B = 0.046, p = .41). There were no between-group differences in social outcomes when outcomes were stratified by original arm of randomisation. Patients had a mean of 10.2 (SD = 5.9) contacts in their social networks, 42% of whom were relatives.


CTO duration was not associated with improvements in patients’ social outcomes even over the long term. This study adds to growing concerns about CTO effectiveness and the justification for their continued use.


Social networks Objective social outcomes Health-related quality of life Capabilities, OxCAP-MH Longitudinal 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Research Unit On Children’s Psychosocial MaladjustmentUniversity of MontrealMontrealCanada
  2. 2.Department of PsychiatryUniversity of OxfordOxfordUK
  3. 3.Health Services Research UnitAkershus University HospitalLørenskogNorway
  4. 4.Centre for Care ResearchUniversity College of Southeast NorwayNotoddenNorway
  5. 5.Nuffield Department of Primary Healthcare SciencesUniversity of OxfordOxfordUK
  6. 6.Department of Health Economics, Centre for Public HealthMedical University of ViennaViennaAustria
  7. 7.Health Economics Research Centre, Nuffield Department of Population HealthUniversity of OxfordOxfordUK

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