Poster #S131 USE AND ABUSE: THE ROLE OF COMMUNITY TREATMENT ORDERS IN AN INTENSIVE OUTREACH TEAM

2014 ◽  
Vol 153 ◽  
pp. S136
Author(s):  
Carol Silberberg
Keyword(s):  
Community Treatment ◽  
Community Treatment Orders ◽  
Outreach Team

Community treatment order legislation in the Commonwealth

2016 ◽  
Author(s):  
John Dawson
Keyword(s):  
Outpatient Treatment ◽  
Community Care ◽  
Common Law ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Treatment Plans ◽  
The Uk ◽  
Treatment Order ◽  
Community Treatment Order

This chapter provides an overview of legislation governing the use of community treatment orders (CTOs)—that authorize compulsory outpatient treatment—in the UK, Canada, Australia, and New Zealand. It focuses particularly on the cluster of powers that CTOs confer on community mental health teams, permitting them to continue supervising a person’s outpatient care. It covers the criteria, procedures, and structure of authority for a CTO, the conditions such an order can impose on a person’s community care, the role of statutory treatment plans, and the powers available to enforce the outpatient treatment regime, especially the power of recall to hospital—analysing and comparing the subtly different regimes enacted in these Commonwealth nations that share a common law tradition.

scholarly journals The effectiveness of community treatment orders (CTOS) across Birmingham and Solihull Mental Health Foundation Trust (BSMHFT)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S94-S95
Author(s):  
Sambavi Navaratnarajah ◽  
Riya Basu ◽  
Syed Rashid
Keyword(s):  
Mental Health ◽  
Revolving Door ◽  
Community Treatment ◽  
List Type ◽  
Community Treatment Orders ◽  
Prompt Treatment ◽  
Timely Fashion ◽  
Bed Days ◽  
Mental Health Foundation

AimsTo ascertain if CTOs ensure that patients are effectively treated in the community and maintain stability in their mental health.If a patient requires recall(+/- revocation) that this is done in a timely fashion in according to the 1983 Mental Health Act.BackgroundA number of studies have been inconclusive in determining the benefits of CTOs in reducing the re-admissions of “revolving door” patients In Assertive Outreach (AO). It is felt that CTOs have reduced readmission of patients due to the intensive input from community teams, decreased recall and subsequent revocation. Those admitted are thought to require fewer inpatient days. It is clear that many patients who require recall following non-engagement, non-compliance, will accept medication following RC review. However at present in BSMHFT patients can only be recalled if they are allocated a bed. Due to the national bed shortage, this has resulted in delays following decision to recall and thus early and effective treatment for patients. In this aspect it defeats the role of the CTO as per the 2007 MHA.MethodCTO data from 1st April 2018 to 31st March 2019 was obtained from all 6 AOT's in BSMHFT. The following factors were considered; 1.Time between decision to recall by RC and recall to inpatient facility2.Number of recalls converted to revocations3.Number of inpatient bed days if revoked4.Number of admissions on CTO5.Patient/family agreement of CTOResult98 CTO patients were recorded over this period. 19 out of 26 recalls had recall dates documented. 10 recalls were revoked due to relapse of mental illness. Average days from RC recall decision to actual recall or cancellation was 63.89 days. Main reasons for delay were bed unavailability and execution of warrant.Following revocation, average inpatient bed days was 103.71. 41% of families agreed with CTOs, 36% of patients contested their CTO.ConclusionOver a quarter of patients on CTO were recalled to hospital however, less than half of these had their CTO revoked. The remainder accepted treatment following urgent community review whilst on the bed list. Evidently the majority of patients didn't need admission. With the ongoing bed crisis, alternative avenues need to be sought to ensure prompt treatment and prevent relapse.A CTO suite designed for recall could be the solution for the future.

scholarly journals Impact of community treatment orders on inpatient bed usage in assertive outreach team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S233-S234
Author(s):  
Mohammed Al-Uzri ◽  
Zena Harvey ◽  
Fabida Noushad ◽  
Chinyere Iheonu ◽  
Mohammed Abbas
Keyword(s):  
Inpatient Care ◽  
Mean Difference ◽  
Community Treatment ◽  
Controlled Study ◽  
Community Treatment Orders ◽  
Post Discharge ◽  
Assertive Outreach ◽  
Outreach Team ◽  
Bed Days ◽  
The Impact

AimsTo examine the impact of using Communty Treatment Orders (CTO) of the Mental Health Act on use of inpatient care in Assertive Outreach team.BackgroundCurrently there is little evidence of the efficacy of community treatment orders (CTOs), and in particular with patients who use the Assertive Outreach service. One large randomised controlled study found no impact on use of inpatient care while a naturalistc study found significant impact.MethodOur primary outcome was the number of admissions with and without a CTO comparing each patient with themselves before CTO and under CTO(“mirror-image”). Our secondary outcomes were the number of bed days, and the percentage of missed community visits post-discharge. We also looked at the potential cost savings of a reduction in inpatient bed usage.ResultAll the 63 patients studied over period of 6 years had a severe and enduring mental illness. The use of a CTO was linked to a significant reduction in the number of admissions (mean difference = 0.89, 95% CI = 0.53–1.25, P < 0.0001) and bed days (mean difference = 158.65, 95% CI = 102.21–215.09, P < 0.0001) There was no significant difference in the percentage of missed community visits post-discharge. Looking at the costs, an average cost for an inpatient Assertive Outreach bed per day in the local Trust was £250, and there were 8145 bed days saved in total, making a potential saving of just over £2million, during the study period.ConclusionThis study suggests that the implementation of CTOs using clinical judgment and knowledge of patients can significantly reduce the bed usage of Assertive Outreach patients. The financial implications of CTOs need to be reviewed further, but this study does suggest that the implementation of CTOs is a cost-effective intervention and is economically advantageous to the local Trust.

scholarly journals Involuntary treatment in the community: role of community treatment orders

2010 ◽  
Vol 34 (10) ◽  
pp. 441-446 ◽  
Author(s):  
Sarah Woolley
Keyword(s):  
Mental Health ◽  
Evidence Based Medicine ◽  
Community Treatment ◽  
Evidence Based ◽  
Involuntary Treatment ◽  
Community Treatment Orders ◽  
Literature Reviews ◽  
The Common ◽  
Based Medicine

SummaryAlthough community treatment orders (CTOs) have been used internationally since the 1980s, they were only introduced into England and Wales in 2007 by amendments to the 1983 Mental Health Act. Aimed to replace the common use of extended Section 17 leave to enforce community treatment, CTOs are believed to offer patients more protection owing to stringent criteria for their use. Literature reviews, however, do not demonstrate any evidence favouring the use of CTOs and in this age of evidence-based medicine it is questionable whether psychiatrists will change from a familiar practice to an unproven one.

scholarly journals Community treatment orders: Are they useful?

2017 ◽  
Vol 23 (4) ◽  
pp. 222-230 ◽  
Author(s):  
Jorun Rugkåsa ◽  
Tom Burns
Keyword(s):  
Hospital Admissions ◽  
Evidence Base ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Ongoing Debate ◽  
Current Controversy ◽  
Treatment Plans ◽  
The Uk ◽  
Different Levels

SummaryIn the wake of the deinstitutionalisation of mental health services, community treatment orders (CTOs) have been introduced in around 75 jurisdictions worldwide. They make it a legal requirement for patients to adhere to treatment plans outside of hospital. To date, about 60 CTO outcome studies have been conducted. All studies with a methodology strong enough to infer causality conclude that CTOs do not have the intended effect of preventing relapse and reducing hospital admissions. Despite this, CTOs are still debated, possibly reflecting different attitudes to the role of evidence-based practice in community psychiatry. There are clinical, ethical, legal, economic and professional reasons why the current use of CTOs should be reconsidered.Learning Objectives• Gain an overview of the development and use of CTOs in the UK and internationally• Get up-to-date information about the evidence base for CTO effectiveness and the relative contributions of different levels of evidence• Appreciate the nature of the current controversy around the use of CTOs and become familiar with the factors in the ongoing debate about their future

„MAGIŠKASIS KAMBARYS“: GYVYBINGA IR PRISITAIKANTI VAISTINĖLĖS TRADICIJA LIETUVOS BAJORŲ NAMUOSE

2018 ◽  
pp. 164-195
Author(s):  
Marius Daraškevičius
Keyword(s):  
Twentieth Century ◽  
Personal Space ◽  
Community Treatment ◽  
Early Twentieth Century ◽  
Single Room ◽  
Late Eighteenth ◽  
Manor House ◽  
Medicine Cabinet ◽  
Culture Education

The article discusses the causes of emergence and spreading of a still room (Lith. vaistinėlė, Pol. apteczka), the purpose of the room, the location in the house planning structure, relations to other premises, its equipment, as well as the role of a still room in everyday culture. An examination of the case of a single room, the still room, in a noblemen’s home is also aimed at illustrating the changes in home planning in the late eighteenth – early twentieth century: how they adapted to the changing hygiene standards, perception of personal space, involvement of the manor owners in community treatment, and changes in dining and hospitality culture. Keywords: still room, household medicine cabinet, manor house, interior, sczlachta culture, education, dining culture, modernisation, Lithuania.

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