Abstract
BackgroundRandomised studies consistently show that Community Treatment Orders (CTOs) do not have the intended effect of preventing relapse and readmissions of patients with severe and enduring mental illness. Critics suggest this in part can be explained by RCTs studying newly introduced CTO regimes and that patients therefore were not brought back to hospital for short-term observations (‘recall’) as frequently as intended. Our purpose was (i) to test the hypothesis that CTO practice as regards recall of patients to hospital in England and Wales was as rigorous under the OCTET trial period as in current routine use and (ii) to investigate the reasons for and outcomes of recalls and whether this changed over time.MethodThirty six-month observational prospective study of 198 patients in the OCTET Follow-up Study.ResultsForty percent of patients were recalled, 19 % more than once. This is in line with current national use. Deterioration in clinical condition was the most common reason for recalls (49 %), and 68 % of recalls resulted in revocation of the order (i.e., retention in hospital under compulsion). This pattern remained stable over time.ConclusionThe use of recall cannot explain why RCTs have not confirmed any benefits from CTOs, and their continued use should be reconsidered.Trial registrationThe OCTET Trial was retrospectively registered on 12 November 2009 (ISRCTN73110773)
Highlights
Randomised studies consistently show that Community Treatment Orders (CTOs) do not have the intended effect of preventing relapse and readmissions of patients with severe and enduring mental illness
As we have previously reported, the 198 patients stayed on CTO for one year on average [12], which means our recall rate of 40 % is broadly comparable with the current national rate of around 43 % over 12 months [16]
Our findings support our hypothesis that the use of recall of CTO patients to hospital over the course of the Oxford Community Treatment Order Evaluation Trial (OCTET) Randomised controlled trial (RCT) was in line with mature practice nationally
Summary
Randomised studies consistently show that Community Treatment Orders (CTOs) do not have the intended effect of preventing relapse and readmissions of patients with severe and enduring mental illness. Critics suggest this in part can be explained by RCTs studying newly introduced CTO regimes and that patients were not brought back to hospital for short-term observations (‘recall’) as frequently as intended. CTOs permits compulsory treatment outside of hospital They target patients deemed to need supervision but who are well enough for this to CTOs were introduced into the amended Mental Health Act for England and Wales (MHA) in November 2008 [2].
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