Sunday, April 21, 2013

Community Treatment Orders - superficially appealing

It's really quite amazing that the British psychiatrist who was a champion of Community Treatment Orders, tested his own theory (published in The Lancet) and acknowledges that he was wrong. The evidence suggests CTOs don't work. The re-hospitalization percentage was the same for both groups (those force treated for a short time) and those on CTOs. In my opinion, the damage inflicted on the CTO patient in the form of stigma and loss of civil liberties is a big contributor to worse mental health outcomes over time.

From The Independent

In the study, researchers compared two separate groups of mentally ill patients to test if they experienced fewer hospital admissions. The first set of 166 patients were under CTOs, which can initially last for up to six months and can be renewed at the end of this period. Meanwhile, the other 167 participants tested had been placed on Section 17 leave, which is intended to be only a very short-term solution and can last a matter of days.

Their findings, published in The Lancet this month, revealed that 36 per cent of patients in both groups were readmitted to hospital within one year. There were no significant differences between the two groups in terms of the frequency and duration of admissions, the study found.

Both sets of patients were also remarkably similar in their social and medical outcomes.

Professor Burns added: "We were all a bit stunned by the result, but it was very clear data and we got a crystal clear result. So I've had to change my mind. I think sadly – because I've supported them for 20-odd years – the evidence is staring us in the face that CTOs don't work."

The Lancet study

The Lancet, Early Online Publication, 26 March 2013
This article can be found in the following collections: Psychiatry (Schizophrenia)

Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial

Prof Tom Burns DSc, Jorun RugåsPhD, Andrew Molodynski MBChB , John Dawson LLD, Ksenija Yeeles BSc , Maria Vazquez-Montes PhD, Merryn Voysey MBiostat, Julia Sinclair DPhil, Prof Stefan Priebe FRCPsych 


In well coordinated mental health services the imposition of compulsory supervision does not reduce the rate of readmission of psychotic patients. We found no support in terms of any reduction in overall hospital admission to justify the significant curtailment of patients' personal liberty.


  1. Rossa,

    Who know, maybe one day psychiatry will come to appreciate the obvious. I've always liked this quote:

    "Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience." - C. S. Lewis

    Be well,


    1. Interesting that C.S. Lewis said that. Scary that The Treatment Advocacy Center cites 20 years of research coming to exactly the opposite conclusion. Which study lies closer to the truth?

      SUMMARY: Forty-four states permit the use of assisted outpatient treatment (AOT), also called outpatient commitment. AOT is court-ordered treatment (including medication) for individuals who have a history of medication noncompliance, as a condition of their remaining in the community. Studies and data from states using AOT prove that it is effective in reducing the incidence and duration of hospitalization, homelessness, arrests and incarcerations, victimization, and violent episodes. AOT also increases treatment compliance and promotes long-term voluntary compliance, while reducing caregiver stress. The six states that do not have AOT are Connecticut, Maryland, Massachusetts, New Mexico, Nevada, and Tennessee.

  2. Rossa,

    Forty-four states get it wrong.
    Six states, and of course C.S. Lewis, get it right.



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