Community treatment orders: an analysis of the first five years of use in England

Abstract

The number of new CTOs each year ranged between 3834 and 4647. The number subject to a CTO per 100 000 population increased from 6.4 in 2009/10 to 10.0 in 2013/14. There was variation between NHS trusts in the use of CTOs when compared with the number of involuntary detentions CONCLUSIONS: The number of patients on CTOs increased year on year. Those on forensic sections were more likely to be discharged on a CTO than those on civil sections. There was considerable variation in the pattern of use between hospitals. Declaration of interest None.

Use of community treatment orders and their outcomes: an observational study

“…30 In England, routine statistics suggest significant differences between service providers, 25 a point emphasised by recent research exploring these data. 29,31 Again, however, little attempt has been made to relate spatial variations in CTO use to patient demographic or clinical characteristics, or, indeed, to the characteristics of the areas or service providers themselves.…”

Factors influencing use of community treatment orders and quality of care that people receive: results of a national survey in England and Wales

“…Trevithick and colleagues noted that trusts serving large urban centres have higher rates of CTO use. 8 Studies have also shown that there are higher rates of CTO use in trusts that provide specialist services for people with intellectual disability. 8,31 Another reason for differences in levels of use of CTOs in different parts of the country could be continuing uncertainty about the clinical effectiveness of this approach to helping people with psychosis.…”

“…8 Studies have also shown that there are higher rates of CTO use in trusts that provide specialist services for people with intellectual disability. 8,31 Another reason for differences in levels of use of CTOs in different parts of the country could be continuing uncertainty about the clinical effectiveness of this approach to helping people with psychosis. While the results of the OCTET trial and other randomised trials of compulsory community treatment suggest that CTOs do not reduce use of in-patient services or lead to improved mental health or quality of life, 17,18 questions have been raised about whether the results of these trials can be generalised to routine clinical settings 37 and many psychiatrists remain convinced of their benefit.…”

“…4,5 Although CTOs have been recommended as a method for improving adherence and patient safety, patients treated under CTOs feel more coerced. 6 The use of CTOs has been much higher than was initially anticipated, 7,8 and has increased considerably since they were first introduced. 8,9 Concerns have been raised about greater use of compulsion amongst people from ethnic minority communities.…”

“…6 The use of CTOs has been much higher than was initially anticipated, 7,8 and has increased considerably since they were first introduced. 8,9 Concerns have been raised about greater use of compulsion amongst people from ethnic minority communities. [10][11][12] Data submitted to NHS Digital in 2016 indicated that Black or Black British patients were almost nine times more likely to be treated on a CTO than White British patients.…”