Abstract
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.
Highlights
Since the debate that preceded the introduction of community treatment orders (CTOs) in England and Wales to a large extent focused on the circumstances surrounding the issuing of and discharge from CTOs, we report on these data in greatest detail (Tables 1 and 2)
Our survey suggests that there has been a noticeable shift in the profession’s views on CTOs since the previous survey by Crawford et al,[1] our response rate means some caution is needed when comparing the results directly. The proportion of those preferring to work in a system with CTOs seems to have increased substantially
In New Zealand, rates of preference for a regime involving community compulsion were 79% when surveyed after powers were well embedded into practice, and it might be the case that we will continue to see increased support for the regime in this jurisdiction
Summary
Of the 1928 surveys sent out, 714 were returned, an overall response rate of 37%. Of these, 566 (29% of the total sample) were usable, the remainder being either identified as duplicates, incorrectly filled out, or left entirely blank. The remaining factors, in order of importance, were: a CTO commits service providers to the person (2.76), gives others the confidence to care for the person (2.79), binds community services in place (2.89), encourages the individual to take responsibility (3.15), mobilises social support for the individual (3.25); and the individual gives up conflict areas to external agents (3.30) These rankings are very similar to those in the New Zealand study. Nine possible factors which could potentially act as barriers to the effectiveness of CTOs were rated by respondents Those considered most undermining (i.e. lowest mean score) were judged to be substance misuse (2.06), lack of supported accommodation for people with challenging behaviours (2.17), and failure to enforce medication adherence (2.45). Whereas the estimates at the extreme ends of this continuum probably reflect strong views about CTOs and not serious suggestions regarding levels of use, the most commonly given figure was 2000 per annum, substantially less than that recorded since November 2008
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