Abstract
Aims and method To compare admission rates and bed occupancy before and after the introduction of community treatment orders (CTOs) in 37 assertive outreach service patients. The effect of CTOs on treatment adherence and illicit drug use were also evaluated. The views of patients and care coordinators were obtained through a focus group.Results When CTOs were introduced, admission rates fell from 3.3 to 0.3 per year and average bed occupancy declined from 133.2 to 10.8 days per year. Treatment adherence improved from 4 (10.8%) to 31 (83.7%) patients, and an objective reduction in substance misuse was observed in 25 (67.5%) patients. Whereas patients expressed ambivalence towards CTOs, their care coordinators generally had a more positive view.Clinical implications The decline in hospital usage following the introduction of CTOs is encouraging and could reflect improved adherence and engagement through intensive case management, leading to a reduction in readmissions. However, further studies need to look at quality of life, cost-effectiveness and the impact on patients.
Highlights
In 1998 the government started the process of reforming the mental health law in England and Wales resulting in amendments to the Mental Health Act 1983 and introducing supervised community treatment (SCT) orders - or community treatment orders (CTOs) as they are more commonly known - in 2008
A total of 37 patients were identified in the City and Hackney Assertive Outreach Service (CHAOS) caseload who had been subject to a CTO for a minimum of 6 months during the study period
In North America, CTOs were established in the 1980s to address this problem
Summary
A total of 37 patients were identified in the CHAOS caseload who had been subject to a CTO for a minimum of 6 months during the study period This was deemed an adequate sample size and study period (40.7 patient years on a CTO compared with 74 pre-CTO patient years) to meaningfully measure any impact of the intervention, especially in the absence of such studies in the UK. The average bed occupancy during the pre-CTO period was 133.2 days per year (range 40-365) compared with 10.8 per year during the CTO period, a decline of 92%. In 12 of the 20 patients on oral medication there was evidence of attempts at progressive transfer of responsibility and self-medication with increasing insight and motivation For these 12 patients collection of repeated prescriptions was used as a measure of adherence. The contrast between the views of the patients and the care coordinators points to the difference in perspectives on the use of CTOs in the community
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