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A systematic review of the effect of community treatment orders on service use

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

The evidence regarding community treatment order effectiveness has been conflicting. This systematic review aims to bring up to date the review performed by Churchill and colleagues in 2005 by assessing and interpreting evidence of CTO effectiveness defined by admission rates, number of inpatient days, community service use, and medication adherence published since 2006.

Method

Databases were searched to obtain relevant studies published from January 2006 to March 2013.

Results

18 studies including one randomised controlled trial were included. There remains lack of evidence from randomised and non-randomised studies that CTOs are associated with or affected by admission rates, number of inpatient days or community service use. The most recent and largest RCT is included in this review and found no significant impact on admission rate (RR = 1.0, 95 % CI 0.75–1.33) or number of days in hospital (IR = 0.90, 95 % CI 0.65–1.26). Results from the two largest longitudinal datasets included in this review do not concur. Studies using the New York dataset found that CTOs were associated with reduced admission rates and inpatient days, while studies using the Victoria dataset generally found that they were associated with increased admission rates and inpatient days.

Conclusion

There is now robust evidence in the literature that CTOs have no significant effects on hospitalisation and other service use outcomes. Non-randomised studies continue to report conflicting results. Distinguishing between CTO recall and revocation and different patterns of community contact is needed in future research to ensure differentiation between CTO process and outcome.

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Conflict of interest

All authors declare that they have no conflict of interest

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Authors and Affiliations

  1. Oxford Health NHS Foundation Trust, Oxford, UK

    Daniel Maughan, Andrew Molodynski, Jorun Rugkåsa & Tom Burns

  2. Social Psychiatry Group, Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Lane, Oxford, OX3 7JX, UK

    Daniel Maughan, Andrew Molodynski, Jorun Rugkåsa & Tom Burns

  3. Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway

    Jorun Rugkåsa

Authors
  1. Daniel Maughan
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  2. Andrew Molodynski
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  3. Jorun Rugkåsa
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  4. Tom Burns
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Correspondence to Daniel Maughan.

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Maughan, D., Molodynski, A., Rugkåsa, J. et al. A systematic review of the effect of community treatment orders on service use. Soc Psychiatry Psychiatr Epidemiol 49, 651–663 (2014). https://doi.org/10.1007/s00127-013-0781-0

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  • DOI: https://doi.org/10.1007/s00127-013-0781-0

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