scholarly journals Use of community treatment orders in an inner-London assertive outreach service

2014 ◽  
Vol 38 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Muffazal Rawala ◽  
Susham Gupta
Keyword(s):  
Treatment Adherence ◽  
Community Treatment ◽  
Bed Occupancy ◽  
Community Treatment Orders ◽  
Assertive Outreach ◽  
Admission Rates ◽  
Outreach Service ◽  
Objective Reduction ◽  
Care Coordinators ◽  
The Impact

Aims and methodTo compare admission rates and bed occupancy before and after the introduction of community treatment orders (CTOs) in 37 assertive outreach service patients. The effect of CTOs on treatment adherence and illicit drug use were also evaluated. The views of patients and care coordinators were obtained through a focus group.ResultsWhen CTOs were introduced, admission rates fell from 3.3 to 0.3 per year and average bed occupancy declined from 133.2 to 10.8 days per year. Treatment adherence improved from 4 (10.8%) to 31 (83.7%) patients, and an objective reduction in substance misuse was observed in 25 (67.5%) patients. Whereas patients expressed ambivalence towards CTOs, their care coordinators generally had a more positive view.Clinical implicationsThe decline in hospital usage following the introduction of CTOs is encouraging and could reflect improved adherence and engagement through intensive case management, leading to a reduction in readmissions. However, further studies need to look at quality of life, cost-effectiveness and the impact on patients.

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 Impact of compulsory community treatment on admission rates

2004 ◽  
Vol 184 (5) ◽  
pp. 432-438 ◽  
Author(s):  
Stephen R. Kisely ◽  
Jianguo Xiao ◽  
Neil J. Preston
Keyword(s):  
Health Service ◽  
Service Use ◽  
Psychiatric Patients ◽  
Community Treatment ◽  
Health Service Use ◽  
Community Treatment Orders ◽  
Stage Design ◽  
Admission Rates ◽  
Compulsory Community Treatment ◽  
Socio Demographic Factors

BackgroundThere is controversy as to whether compulsory community treatment for psychiatric patients reduces hospital admission rates.AimsTo examine whether community treatment orders (CTOs) reduce admission rates, using a two-stage design of matching and multivariate analyses to take into account socio-demographic factors, clinical factors, case complexity and previous psychiatric and forensic history.MethodSurvival analysis of CTO cases and controls from three linked Western Australian databases of health service use, involuntary treatment and forensic history. We used two control groups: one matched on demographic characteristics, diagnosis, past psychiatric history and treatment setting, and consecutive controls matched on date of discharge from in-patient care.ResultsWe matched 265 CTO cases with 265 matched controls and 224 consecutive controls (totaln=754). The CTO group had a significantly higher readmission rate: 72%v.65% and 59% for the matched and consecutive controls (log-rank χ2=4.7,P=0.03). CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were associated with increased admission rates.ConclusionsCommunity treatment orders alone do not reduce admissions.

scholarly journals Community treatment orders and their use in the UK

2010 ◽  
Vol 16 (4) ◽  
pp. 260-262 ◽  
Author(s):  
Mark Taylor
Keyword(s):  
Treatment Adherence ◽  
Scientific Evidence ◽  
Health Needs ◽  
Community Treatment ◽  
Compulsory Treatment ◽  
Ethical Considerations ◽  
Community Treatment Orders ◽  
England And Wales ◽  
The Uk

SummaryDespite the lack of supportive scientific evidence, the uptake of community treatment orders (CTOs) in England and Wales since their introduction in late 2008 has been higher than expected, although there has been a relative dearth of second opinion appointed doctors. In Scotland, CTOs now constitute about 30% of all long-term civil detentions, with lack of insight and lack of treatment adherence given as the major reasons for CTO use. Ethical considerations such as balancing autonomy against health needs will continue to be weighed by clinicians considering compulsory treatment in the community.

scholarly journals Community Treatment Orders in Victoria, Australia

1990 ◽  
Vol 14 (8) ◽  
pp. 462-464 ◽  
Author(s):  
Paul Dedman
Keyword(s):  
Psychiatric Patient ◽  
Community Treatment ◽  
Compulsory Admission ◽  
Front Line ◽  
Community Treatment Orders ◽  
High Turnover ◽  
Community Based ◽  
Neuroleptic Medication ◽  
Assertive Outreach ◽  
Social Milieu

It is one of the failures of contemporary psychiatry that many patients who respond well to neuroleptic medication given to them when they are in-patients relapse after discharge due to not taking any further medication. Those working closely with the acute psychiatric patient in the community are often forced to stand by powerlessly as a patient deteriorates, causing damage to himself and his social milieu until such a point is reached when he is again ill enough to warrant compulsory admission and treatment. This process is, of course, devastating for a patient's family and also disheartening for professionals involved, and is perhaps partly responsible for the high turnover of staff involved in front line services. Even if assertive outreach methods are employed such as those involved in a number of comprehensive community-based programmes (Stein & Test, 1980; Borland et al, 1989) so that contact with the patient is not lost, it is not possible without the necessary legislation to enforce treatment in the community.

Characteristics of people on community treatment orders in Australia: Data from the 2010 National Survey of High Impact Psychosis

2021 ◽  
pp. 000486742110360
Author(s):  
Shuichi Suetani ◽  
Steve Kisely ◽  
Stephen Parker ◽  
Anna Waterreus ◽  
Vera A Morgan ◽  
...  
Keyword(s):  
Substance Use ◽  
Social Functioning ◽  
Psychiatric Inpatient ◽  
Community Treatment ◽  
Service Utilisation ◽  
Treatment Needs ◽  
Community Treatment Orders ◽  
Admission Rates ◽  
Treatment Order ◽  
Community Treatment Order

Objective: Existing evidence on factors associated with community treatment order placement is largely restricted to administrative data. We utilised the data from a large nationally representative sample to compare the demographic, clinical, social functioning, substance use and service utilisation profiles of people living with psychosis under community treatment orders with those who were not. Methods: Participants were grouped based on whether they had been subject to a community treatment order in the past 12 months or not. We conducted logistic regressions to examine demographic, clinical, social functioning, substance use and service utilisation profiles associated with the two groups. Results: People who had recently been subject to community treatment orders were more likely to be treated with long-acting injectable antipsychotics and lacked insight but were less likely to report suicidal ideation. They also had higher psychiatric inpatient admission rates but a lower frequency of general practitioner visits. Conclusion: People on community treatment orders in Australia may differ from those who are not under a community treatment order in their treatment needs. Resources and care provision must match the needs of this particularly vulnerable group.

Community Treatment Orders: Relationship to Clinical Care, Medication Compliance, Behavioural Disturbance and Readmission

2000 ◽  
Vol 34 (5) ◽  
pp. 801-808 ◽  
Author(s):  
Kevin Vaughan ◽  
Neil McConaghy ◽  
Cherry Wolf ◽  
Craig Myhr ◽  
Terry Black
Keyword(s):  
Readmission Rate ◽  
Comparison Group ◽  
Clinical Care ◽  
Severity Of Illness ◽  
Community Treatment ◽  
Control Group ◽  
Random Allocation ◽  
Community Treatment Orders ◽  
Readmission Rates ◽  
The Impact

Objective: The objective of this study was to investigate the readmission rate, and the level of patient disturbance and community care associated with readmission following Community Treatment Orders (CTOs) in New South Wales, Australia. Method: The readmission rates of all patients given CTOs within a 4-year period and a matched comparison group were investigated. The following factors were compared before, during and following a CTO: medication non-compliance, number of clinical services and duration of disturbed behaviour preceding hospitalisations. Results: Of 123 patients on CTOs (mean length, 288 days; SD, 210 days), 38 were readmitted during the CTO, the majority in the first 3 months and a further 21 patients were readmitted following termination of the CTO. Evidence of lower severity of illness in the comparison patients prevented meaningful evaluation of the readmission rates of the two groups. While on CTOs, patients receiving depot medications showed high compliance and a significantly reduced readmission rate compared with that of patients receiving oral medications. In the 2 months prior to hospitalisations during CTOs, compared with those before or after CTOs, patients received more frequent consultations and showed a shorter duration of medication non-compliance and disturbed behaviour. The level of services in the 3 months following discharge were comparable for patients on CTOs and the comparison group. Conclusions: CTOs may reduce rehospitalisations by use of depot medication. Earlier and possibly more frequent readmissions in the CTO group shortened the disturbance associated with illness recurrence. It would appear that to establish a control group with equivalent severity of disorder necessary to evaluate the impact of CTOs requires a random allocation design.

Community Treatment Orders in Victoria: A Clinico-Ethical Perspective

2008 ◽  
Vol 16 (5) ◽  
pp. 340-343 ◽  
Author(s):  
Gunvant Patel
Keyword(s):  
Clinical Practice ◽  
Service Delivery ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Ethical Perspective ◽  
Human Rights Protection ◽  
Rights Protection ◽  
Optimal Service ◽  
Psychiatric Profession ◽  
The Impact

Objective: The aim of this paper is to outline the impact of Community Treatment Orders over a 20-year period on service delivery and clinical practice in Victoria. Conclusions: Community Treatment Orders, as utilized in Victoria, have undermined optimal service delivery and supported paternalistic, reductionistic clinical practice. The psychiatric profession has failed to advocate adequately for better mental health resourcing and human rights protection of those subject to Community Treatment Orders.

scholarly journals Changes to mental healthcare for working age adults: impact of a crisis team and an assertive outreach team

2007 ◽  
Vol 31 (8) ◽  
pp. 288-292 ◽  
Author(s):  
Patrick Keown ◽  
Mary Jane Tacchi ◽  
Stephen Niemiec ◽  
John Hughes
Keyword(s):  
Length Of Stay ◽  
Mental Healthcare ◽  
Clinical Implications ◽  
Bed Occupancy ◽  
Crisis Resolution ◽  
Median Length ◽  
Assertive Outreach ◽  
Working Age ◽  
Psychiatric Beds ◽  
The Impact

Aims and MethodTo investigate changes to admissions, compulsory detentions, diagnosis, length of stay and suicides following introduction of crisis resolution home treatment and assertive outreach teams.ResultsThere was a 45% reduction in admissions with an increase in the median length of stay from 15.5 to 25 days. Bed occupancy fell by 22%. The number of suicides remained constant. Detentions under sections 2 and 3 of the Mental Health Act 1983 increased whereas those under sections 5(2) and 5(4) declined.Clinical ImplicationsThe introduction of crisis and assertive outreach teams was followed by a reduction in admissions, particularly short admissions. The impact differed according to gender (reduction in female bed occupancy). This and the increased length of stay need to be considered when determining the number of acute psychiatric beds needed.

scholarly journals Community treatment orders in the UK 5 years on: a repeat national survey of psychiatrists

2016 ◽  
Vol 40 (3) ◽  
pp. 119-123 ◽  
Author(s):  
Ritz DeRidder ◽  
Andrew Molodynski ◽  
Catherine Manning ◽  
Pearse McCusker ◽  
Jorun Rugkåsa
Keyword(s):  
Clinical Practice ◽  
Patient Care ◽  
Treatment Adherence ◽  
National Survey ◽  
Community Treatment ◽  
Clinical Implications ◽  
Clinical Factors ◽  
Previous Survey ◽  
Community Treatment Orders ◽  
The Uk

Aims and methodCommunity treatment orders (CTOs) are increasingly embedded into UK practice and their use continues to rise. However, they remain highly controversial. We surveyed psychiatrists to establish their experiences and current opinions of using CTOs and to compare findings with our previous survey conducted in 2010.ResultsThe opinions of psychiatrists in the UK have not changed since 2010 in spite of recent evidence questioning the effectiveness of CTOs. Clinical factors (the need for engagement and treatment adherence, and the achievement of adherence and improved insight) remain the most important considerations in initiating and discharging a CTO.Clinical implicationsGiven the accumulating evidence from research and clinical practice that CTOs do not improve outcomes, it is concerning that psychiatrists' opinions have not altered in response, particularly given the implications for patient care.

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