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

2016 ◽  
Vol 40 (3) ◽  
pp. 124-126 ◽  
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.

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

2018 ◽  
Vol 42 (3) ◽  
pp. 119-122 ◽  
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.

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.

A comparison of health service use in two jurisdictions with and without compulsory community treatment

2005 ◽  
Vol 35 (9) ◽  
pp. 1357-1367 ◽  
Author(s):  
STEPHEN KISELY ◽  
MARK SMITH ◽  
NEIL J. PRESTON ◽  
JIANGUO XIAO
Keyword(s):  
Logistic Regression ◽  
Nova Scotia ◽  
Western Australia ◽  
Service Use ◽  
Cox Regression ◽  
Community Treatment ◽  
Psychiatric History ◽  
Admission Rates ◽  
Compulsory Community Treatment ◽  
Bed Days

Background. This study examines whether community treatment orders (CTOs) reduce psychiatric admission rates or bed-days for patients from Western Australia compared to control patients from a jurisdiction without this legislation (Nova Scotia).Method. A population-based record linkage analysis of an inception cohort using a two-stage design of matching and multivariate analyses to control for sociodemographics, clinical features and psychiatric history. All discharges from in-patient psychiatric services in Western Australia and Nova Scotia were included covering a population of 2·6 million people. Patients on CTOs in the first year of implementation in Western Australia were compared with controls from Nova Scotia matched on date of discharge from in-patient care, demographics, diagnosis and past in-patient psychiatric history. We analysed time to admission using Cox regression analyses and number of bed-days using logistic regression.Results. We matched 196 CTO cases with an equal number of controls. On survival analyses, CTO cases had a significantly greater readmission rate. Co-morbid personality disorder and previous psychiatric history were also associated with readmission. However, on logistic regression, patients on CTOs spent less time in hospital in the following year, with reduced in-patient stays of over 100 days.Conclusions. Although compulsory community treatment does not reduce hospital admission rates, increased surveillance of patients on CTOs may lead to earlier intervention such as admission, so reducing length of hospital stay. However, we do not know if it is the intensity of treatment, or its compulsory nature, that effects outcome.

scholarly journals Efficacy of compulsory community treatment and use in minority ethnic populations: A statewide cohort study

2019 ◽  
Vol 54 (1) ◽  
pp. 76-88 ◽  
Author(s):  
Steve Kisely ◽  
Katherine Moss ◽  
Melinda Boyd ◽  
Dan Siskind
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Linguistically Diverse ◽  
Community Treatment ◽  
Culturally And Linguistically Diverse ◽  
Community Treatment Orders ◽  
Diverse Backgrounds ◽  
Compulsory Community Treatment ◽  
Bed Days

Background: There is conflicting and equivocal evidence for the efficacy of compulsory community treatment within Australia and overseas, but no study from Queensland. In addition, although people from Indigenous or culturally and linguistically diverse backgrounds are over-represented in compulsory admissions to hospital, little is known about whether this also applies to compulsory community treatment. Aims: We initially investigated whether people from Indigenous or culturally and linguistically diverse backgrounds in terms of country of birth, or preferred language, were more likely to be on compulsory community treatment using statewide databases from Queensland. We then assessed the impact of compulsory community treatment on health service use over the following 12 months. Compulsory community treatment included both community treatment orders and forensic orders. Methods: Cases and controls from administrative health data were matched on age, sex, diagnosis and time of hospital discharge (the index date). Multivariate analyses were used to examine potential predictors of compulsory community treatment, as well as impact on bed-days, time to readmission or contacts with public mental health services in the subsequent year. Results: We identified 7432 cases and controls from January 2013 to February 2017 (total n = 14,864). Compulsory community treatment was more likely in Indigenous Queenslanders (adjusted odds ratio = 1.45; 95% confidence interval = [1.28, 1.65]) subjects coming from a culturally and linguistically diverse background (adjusted odds ratio = 1.54; 95% confidence interval = [1.37, 1.72]), or those who had a preferred language other than English (adjusted odds ratio = 1.66; 95% confidence interval = [1.30, 2.11]). While community contacts were significantly greater in patients on compulsory community treatment, there was no difference in bed-days while time to readmission was shorter. Restricting the analyses to just community treatment orders did not alter these results. Conclusion: In common with other coercive treatments, Indigenous Australians and people from culturally and linguistically diverse backgrounds are more likely to be placed on compulsory community treatment. The evidence for effectiveness remains inconclusive.

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

2014 ◽  
Vol 38 (1) ◽  
pp. 9-12 ◽  
Author(s):  
Mike Smith ◽  
Tim Branton ◽  
Alastair Cardno
Keyword(s):  
Community Treatment ◽  
Clinical Implications ◽  
Community Treatment Orders ◽  
Descriptive Survey

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.

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.

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

2011 ◽  
Vol 35 (9) ◽  
pp. 328-333 ◽  
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.

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

2013 ◽  
Vol 37 (2) ◽  
pp. 54-57 ◽  
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.

scholarly journals Guardianship under the Mental Health Act 1983

2000 ◽  
Vol 24 (2) ◽  
pp. 51-52 ◽  
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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