Community Treatment Orders Fail to Reduce Readmissions

  • Hospital CorridorResearch has shown that community treatment orders (CTOs) do not cut mental health readmissions to hospital.

    A study on CTOs has found that they are much less effective than was thought, and raises questions that they are not worth the infringement on patients liberties.

     The study testing the effectiveness of CTOs has found that the use of these restrictions does not reduce the rate of readmission to hospital.

    The findings, published today, are based on randomised controlled tests, and compared the outcomes of patients discharged under CTOs with patients discharged under a less restrictive form of supervised community treatment, and concluded there was no reduction despite the extra restrictions on the patient.

    As CTOs involve doctors and mental health professionals imposing strict supervised community treatment on patients, it has made people question whether this is justified if it not effective.

    Steve Chamberlain, chair of The College of Social Work's Approved Mental Health Professional (AMHP) leads network, said that some AMHPs feel it can be "very difficult" to challenge psychiatrists' on their decisions to discharge patients on CTOs, despite being the ones who have to sign off on it.

    He says the study proves findings also shown in American studies:

    "We are responsible for agreeing, or not agreeing, to CTOs and we do sometimes feel uncomfortable with the amount of compulsion that's there.

    But we cannot, as AMHPs, wash our hands of the figures because the fact is if we said no they wouldn't be as high.

    A concern is that, as the Care Quality Commission has noted, there is an over-representation of patients from black, Asian and minority ethnic groups on CTOs.

    If this study is replicated elsewhere you need to question whether CTOs are the wisest thing to do? Is the best thing really to keep people under compulsion when they're no longer in hospital?

    The Department of Health said CTOs were intended to benefit those with a chronic mental disorder that had stabilized following treatment in hospital.

    A spokesperson said:

    Every decision to place someone on supervised community treatment is a clinical decision. There is no right or wrong number of people who should be on a community treatment order at any one time.

    Similarly, decisions about when to take someone off supervised community treatment are a matter for clinical judgement.

    We will, nonetheless, consider the implications of this report carefully.


     Image source:

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