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Community treatment orders: Current evidence and the implications

  • Jorun Rugkåsa (a1) and John Dawson (a2)
Summary

Community treatment orders (CTOs) have been widely introduced to address the problems faced by ‘revolving door’ patients. A number of case–control studies have been conducted but show conflicting results concerning the effectiveness of CTOs. The Oxford Community Treatment Order Evaluation Trial (OCTET) is the third randomised controlled trial (RCT) to show that CTOs do not reduce rates of readmission over 12 months, despite restricting patients' autonomy. This evidence gives pause for thought about current CTO practice. Further high-quality RCTs may settle the contentious debate about effectiveness.

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Copyright
Corresponding author
Jorun Rugkåsa, Health Services Research Unit, Akershus University Hospital, 1478 L⊘renskog, Norway. Email: jorun.rugkasa@ahus.no
Footnotes
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Declaration of interest

J.R. and J.D. were the director and an international advisor respectively of the OCTET study.

Footnotes
References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Community treatment orders: Current evidence and the implications

  • Jorun Rugkåsa (a1) and John Dawson (a2)
Submit a response

eLetters

THE CTO CONUNDRUM

Zekria Ibrahimi, psychiatric patient
06 January 2014

The reappraisal article by Rugkasa and Dawson (1) on CTOs points out that RCTs, which seem more vigorous than case control studies, all indicate CTOs to be ineffective. The OCTET trial in the Lancet implied no benefit for CTOs above controls (2).

But clinicians nonetheless appear attached to CTOs, as a paper in ThePsychiatrist indicates (3).

Why this CTO conundrum, with clinicians gung- ho about a procedure that has no substantial evidence base?

I chanced upon the book, 'Fads and Fallacies in Psychiatry', by Joel Paris (4). Paris describes how fads have gripped pschiatry in the past- such as frontal lobotomy and insulin coma treatment. Paris' conclusion? 'The lesson is that medical enthusiasm, even under desperate cicumstances,needs to be curbed' (5).

A paper in the Lancet critical of insulin coma treatment contributed to its demise (6), yet the Burns paper in the same journal will not eliminate CTOs. These are the product of tabloid hysteria, stigma against schizophrenics, the hostility of confomist society towards outsiders.

Psychiatrists should ask themselves: 'Are CTOs aligned with the criteria of objective science?'

REFERENCES:

(1) Community treatment orders: current evidence and the implicationsRugkasa and Dawson. BJP (2013) 203, 406-408.

(2) Community treatment orders for patients with psychosis: a randomized controlled trial (OCTET). Burns et al. Lancet 2013; 381:1627-33.

(3) Compulsion in the community: mental health professionals' views and experiences of CTOs. D. Coyle et al. The Psychiatrist (2013), 37, 315-321.

(4) Fads and fallacies in psychiatry. Paris. R C Psych Pubs. 2013.

(5) Ibid. pg. 31.

(6) Insulin treatment in schizophrenia: a controlled trial. Ackner et al. Lancet, 205, 607-11.

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Conflict of interest: None declared

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