Community treatment orders offer few social benefits for patients with psychotic illnesses, research finds

First study to test the relationship between the time spent on a CTO and the long-term social outcomes for this group of patients

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Community treatment orders offer few social benefits for people experiencing psychotic illnesses, research has found.

Authors of a study assessing the effectiveness of community treatment orders (CTOs) on people with psychotic illnesses said that the findings “add further weight to claims that the use of community treatment orders in their current form needs to be revised”.

CTOs came into practice in England and Wales in 2008. They allow a person to leave hospital and receive supervised treatment in the community, usually with conditions to help them stay well and avoid readmission.


The 114 patients who took part in the study were selected based on whether they had reached their four-year follow-up date from OCTET. Of the 114, 67% were male, 49% were white male, 33% were black, 15% were Asian and 5% were ‘mixed-other’.

The majority (99%) were unemployed and most (83%) had a diagnosis of schizophrenia, schizotypal or delusional disorder. The remaining 17% had diagnoses of other psychotic illnesses, including bipolar. The group lived across 14 NHS trusts accessible by return day travel from Oxford.

The study was a follow-up to the Oxford Community Treatment Evaluation Trial (OCTET), which assessed the outcomes of patients placed on either a CTO or a section 17 ‘leave of absence’ from hospital. Its findings added to growing concerns about the effectiveness of CTOs and the justification for their continued use, the report said.

The research was the first to test the relationship between time spent on CTOs, part 17A of the Mental Health Act, and the long-term social outcomes for patients with psychotic illnesses who live in the community.

It was published in Social Psychiatry and Psychiatric Epidemiology just before prime minister Theresa May announced an independent review of the Mental Health Act at the Conservative Party conference last month, with the use of CTOs one of the provisions being put under the spotlight.

‘No significant associations’

No significant associations were found between the time spent on a community treatment order during the study and patients’ social network size, objective social outcomes or health-related quality of life at the time of follow-up.

The researchers said the increased level of overall functioning was not surprising as patients were now living in the community, whereas at the time of the OCTET study they were in hospital.

However, their health-related quality of life was significantly lower, which was said to be possibly explained by the lower levels of access patients had to health resources and support when living in the community compared to receiving in-patient care.

The report said: “The findings suggest that a longer duration of CTO does not correspond with measurable improvements in patients’ longer term social situation, despite the curtailment of their personal freedoms.”

‘Social networks’

The research assessed the outcomes of patients placed on either a community treatment order or a section 17 ‘leave of absence’ from hospital.

Researchers collected information about patients’ social interactions from the previous month. Patients were also asked about their employment status and living situation using the Objective Social Outcomes Index, which captures information about a person’s social situations using four domains, and assessed on their health-related quality of life, using a questionnaire.

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4 Responses to Community treatment orders offer few social benefits for patients with psychotic illnesses, research finds

  1. Louise Johnson November 16, 2017 at 6:10 pm #

    That’s because CTOs, from the limited experience I have, are used to medicate in a compulsory way. They should more accurately be called CMOs (Compulsory Medication Orders). Often the only connection with the ‘Community’ is getting people out of hospital.

  2. James November 18, 2017 at 3:39 pm #

    Louise is absolutely correct. There will be no social benefit as the orders are simply to enforce medication compliance and make admission to a psychiatric hospital easier. Any other conditions placed on the CTO cannot realistically be enforced if a persons mental health has not deteriorated as a result of them not complying with the conditions imposed. Obviously the motivating factor in any of the conditions is the threat of recall to hospital, which in itself is something I feel very uneasy about. Care should not be about threatening people to comply with a set of restrictions.

  3. shaun monk November 20, 2017 at 12:29 pm #

    The aim of CTO’s was to reduce the likelihood of readmission to psychiatric hospital of a particular strata of the population, the “revolving door patient”. There is flexibility to employ supplementary conditions in a constructive manner, ie I worked with someone where we used a condition to plan what the service user wanted to achieve. The reality is they have primarily been seen as Community Medication Orders as Louise indicates, but if psychiatrists, cpns, social workers and AMHPs were more creative the social outcomes for service users may be more meaningful.

  4. Sylvia Landells November 20, 2017 at 1:06 pm #

    I am most concerned that CTOs seem to be becoming medication-only orders, possibly exacerbated by the lack of sufficient well-trained staff in mental health, health, and social care services.

    How many of the OCTET follow up study had been assessed holisitically, including under the Care Act for their social needs? What were the outcomes of these assessments?