Is the bark worse than the bite? Additional conditions used within community treatment orders

Aims and methodTo investigate the use of additional conditions attached to community treatment orders (CTOs) and whether they influence the process of recall to hospital. We conducted a retrospective descriptive survey of the records and associated paperwork of all the CTOs started in the trust in the year from January 2010. Each CTO was followed up for 12 months.ResultsA total of 65 CTOs were included in the study; 25 patients were recalled during the study and all but one of these had their CTO revoked and remained in hospital. Each patient whose CTO was revoked had experienced a relapse in their condition. Many patients had not complied with CTO conditions prior to relapsing and could potentially have been recalled earlier.Clinical implicationsOur findings suggest that the breaching of additional CTO conditions does not tend to result in a patient's recall to hospital. This has implications regarding how the workings of CTOs are explained to patients and regarding the utility of additional conditions more generally.

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Community treatment orders in England: review of usage from national data

BJPsych Bulletin ◽

10.1192/bjb.2017.33 ◽

2018 ◽

Vol 42 (3) ◽

pp. 119-122 ◽

Cited By ~ 5

Author(s):

Susham Gupta ◽

Elvan U. Akyuz ◽

Toby Baldwin ◽

David Curtis

Keyword(s):

Mental Health ◽

Service Provision ◽

Psychiatric Service ◽

Community Treatment ◽

Clinical Implications ◽

Economic Downturn ◽

National Data ◽

Community Treatment Orders ◽

England And Wales ◽

Low Rate

Aims and methodCommunity treatment orders (CTOs) have been in used in England and Wales since November 2008; however, their effectiveness has been debated widely, as has the question of which methodology is appropriate to investigate them. This paper uses national data to explore the use of CTOs in England.ResultsAbout 5500 patients are subject to CTOs at any one time. Each year, ~4500 patients are made subject to a CTO each year and ~2500 are fully discharged, usually by the responsible clinician; fewer than half of CTO patients are recalled, and two-thirds of recalls end in revocation. The low rate of CTO discharges by mental health tribunals (below 5%) suggests that they are not used inappropriately.Clinical implicationsThe introduction of CTOs in England has coincided with a reduction in psychiatric service provision due to the economic downturn. Pressures on services might be even more severe if patients currently subject to CTOs instead needed to be detained as in-patients.Declaration of interestNone.

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

BJPsych Bulletin ◽

10.1192/pb.bp.115.050773 ◽

2016 ◽

Vol 40 (3) ◽

pp. 119-123 ◽

Cited By ~ 11

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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Community treatment orders in England and Wales: national survey of clinicians' views and use

The Psychiatrist ◽

10.1192/pb.bp.110.032631 ◽

2011 ◽

Vol 35 (9) ◽

pp. 328-333 ◽

Cited By ~ 26

Author(s):

Catherine Manning ◽

Andrew Molodynski ◽

Jorun Rugkåsa ◽

John Dawson ◽

Tom Burns

Keyword(s):

Decision Making ◽

National Survey ◽

Royal College ◽

Research Evidence ◽

Response Rate ◽

Community Treatment ◽

Clinical Implications ◽

Community Treatment Orders ◽

England And Wales ◽

And Training

Aims and methodTo ascertain the views and experiences of psychiatrists in England and Wales regarding community treatment orders (CTOs). We mailed 1928 questionnaires to members of the Royal College of Psychiatrists.ResultsIn total, 566 usable surveys were returned, providing a 29% response rate. Respondents were generally positive about the introduction of the new powers, more so than in previous UK studies. They reported that their decision-making regarding compulsion was based largely on clinical grounds.Clinical implicationsIn the absence of research evidence or a professional consensus about the use of CTOs, multidisciplinary input in decision-making is essential. Further research and training are urgently needed.

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Community treatment orders and reduced time in hospital: a nationwide study, 2007–2012

BJPsych Bulletin ◽

10.1192/pb.bp.115.051045 ◽

2016 ◽

Vol 40 (3) ◽

pp. 124-126 ◽

Cited By ~ 9

Author(s):

Mark Taylor ◽

Melanie Macpherson ◽

Callum Macleod ◽

Donald Lyons

Keyword(s):

Community Treatment ◽

Clinical Implications ◽

Routine Practice ◽

Psychiatric History ◽

Community Treatment Orders ◽

Hospital Bed ◽

Before And After ◽

National Cohort ◽

Bed Days ◽

Reduced Time

Aims and methodCommunity treatment orders (CTOs) were introduced in Scotland in 2005, but are controversial owing to a lack of supportive randomised evidence. The non-randomised studies provide mixed results on their efficacy and utility. We aimed to examine hospital bed day usage across Scotland both before and after CTOs were initiated in a national cohort of patients, spanning 5 years.ResultsIn total, 1558 individuals who were subject to a CTO between 2007 and 2012, of whom 63% were male, were included. After CTO initiation the number of hospital bed days fell, on average, from 66 to 39 per annum per patient. Those with a longer psychiatric history appeared to benefit more from a CTO, in terms of reduced time in hospital.Clinical implicationsOur data offer cautious support for the use of CTOs in routine practice, in terms of reducing time spent in psychiatric hospital. This finding is balanced by the more rigorous randomised studies which do not find any benefit to CTOs.

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Community treatment orders: current practice and a framework to aid clinicians

The Psychiatrist ◽

10.1192/pb.bp.111.037705 ◽

2013 ◽

Vol 37 (2) ◽

pp. 54-57 ◽

Cited By ~ 21

Author(s):

Peter Lepping ◽

Masood Malik

Keyword(s):

Risk Management ◽

Current Practice ◽

Admission Rate ◽

Community Treatment ◽

Clinical Implications ◽

Community Treatment Orders ◽

The North ◽

North Wales ◽

Report Data ◽

Reasons For Use

Aims and methodCommunity treatment orders (CTOs) have been used more than anticipated. We report data from the North Wales audit about their current use and explain how a SMART framework can be used to potentially improve their effectiveness.ResultsFindings from this audit confirm those from other studies, with the reasons for use of CTOs extending beyond that of medication adherence to risk management. The combined recall and voluntary admission rate was 40%, which raises questions about the effectiveness of CTOs.Clinical implicationsMore research is needed as it remains to be seen whether CTOs are able to achieve their intended aims. The SMART framework can be used to aid clinicians in ensuring that conditions placed on patients have a specific purpose and are clinically meaningful.

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Guardianship under the Mental Health Act 1983

Psychiatric Bulletin ◽

10.1192/pb.24.2.51 ◽

2000 ◽

Vol 24 (2) ◽

pp. 51-52 ◽

Cited By ~ 7

Author(s):

Jenny Shaw ◽

Barbara Hatfield ◽

Sherrill Evans

Keyword(s):

Mental Health ◽

Mental Illness ◽

Social Services ◽

Serious Mental Illness ◽

Community Treatment ◽

Clinical Implications ◽

Community Treatment Orders ◽

Mental Health Act ◽

Illness Category ◽

One Year

Aims and MethodTo describe the extent and variation in the use of Guardianship nationally. The Directors of Social Services were asked to provide details about Guardianship cases on two separate occasions one year apart.ResultsThere were 428 new Guardianship cases in 12 months. At the second enumeration, 73% of cases were within the mental illness category and 47% of these had serious mental illness.Clinical ImplicationsThere is much variation in the use of Guardianship. Further developments of this study will explore the reasons for this variation and will ascertain clinicians' views on Guardianship, supervised discharge and other community treatment orders.

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