Community Treatment Orders: Effectiveness, Understanding and Impact

Community Treatment Orders (CTOs) were one of the most controversial amendments made to the Mental Health Act 1983. In 2008 England and Wales joined Scotland and around 70 different jurisdictions around the world in obliging people to adhere to treatment in the community. The rationale is usually to prevent relapse or provide a less restrictive alternative to hospital for ‘revolving-door patients’ with severe and enduring mental illness. However, despite their widespread use, the evidence for their effectiveness is limited.

Last year the Oxford Community Treatment Order Evaluation Trial (OCTET), the first major evaluation of CTOs in England and Wales, reported its findings. This randomised controlled trial found that the same number of people on CTOs were readmitted to hospital as those on section 17 leave of absence. The extra restrictions placed on people on a CTO did not appear to reduce their readmission rate, as was originally envisaged when the orders were first introduced.

Running alongside the randomised controlled trial was an extensive qualitative study which explored patient, consultant and family carer experiences. Findings from this study may help to explain some of the results of the trial. We are pleased to welcome OCTET researchers at our next International Centre for Mental Health Social Research seminar on 12th February to discuss these emergent findings.

In three interlinked presentations, OCTET researchers will present findings and research in progress from the OCTET programme of work:

• Jorun Rugkåsa will present an up-to-date review of the evidence for the effectiveness of CTOs (including OCTET) and OCTET’s main findings, and discuss the implications of these and the wider current evidence base for the future of CTOs.
• Krysia Canvin will present findings from the qualitative arm. She will juxtapose consultants’ and patients’ interpretations of the CTO’s powers to consider the implications for patients’ experiences and the predictability of CTOs.
• Francis Vergunst will present his ongoing DPhil research in which he is exploring the effect of CTOs on patients’ longer-term social outcomes by assessing patients’ social inclusion, social networks, and capabilities/quality of life.

The seminar will be held from 12 noon to 1.00pm at the University of York and is free and open to all. Further information can be found on the Department of Social Policy and Social Work website.