Skip to main content
×
×
Home

Use of community treatment orders in an inner-London assertive outreach service

  • Muffazal Rawala (a1) and Susham Gupta (a2)
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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Use of community treatment orders in an inner-London assertive outreach service
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Use of community treatment orders in an inner-London assertive outreach service
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Use of community treatment orders in an inner-London assertive outreach service
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Muffazal Rawala (muffazal.rawala@kcl.ac.uk)
Footnotes
Hide All

Declaration of interest

None.

Footnotes
References
Hide All
1 Shadish, WR, Lurigio, AJ, Lewis, DA. After deinstitualization: the present and future of mental health long-term policy. J Soc Issues 1989; 45: 115.
2 Fisher, WH, Geller, JL, Altaffer, F, Bennett, MB. The relationship between community resources and state hospital recidivism. Am J Psychiatry 1992; 149: 385–90.
3 Rose, N. Governing risky individuals: the role of psychiatry in new regimes of control. Psychiatr Psychol Law 1998; 5: 177–95.
4 Appelbaum, PS. Almost a Revolution: Mental Health Law and the Limits of Change. Oxford University Press, 1994.
5 Care Quality Commission. Monitoring the Mental Health Act in 2010/11. CQC, 2011.
6 Burns, T, Rugkasa, J, Molodynski, A, Dawson, J, Yeeles, K, Vazquez-Montes, M, et al. Community treatment orders for patients with psychosis (OCTET): a randomized controlled trial. Lancet 2013; 38: 1627–33.
7 Geller, JL. The last half-century of psychiatric services as reflected in psychiatric services. Psychiatr Serv 2000; 51: 4167.
8 Swartz, MS, Swanson, JW. Involuntary outpatient commitment, community treatment orders, and assisted outpatient treatment: what's in the data? Can J Psychiatry 2004; 49: 585–91.
9 Brophy, L, Ring, D. The efficacy on involuntary treatment in the community: consumer and service provider perspectives. Soc Work Ment Health 2004; 2: 157–74.
10 Churchill, R, Owen, G, Singh, S, Hotopf, M. International Experiences of Using Community Treatment Orders. Department of Health, 2007 (http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072730).
11 Dawson, J. Factors influencing the rate of use of community treatment orders. Psychiatry 2007; 6: 42–4.
12 The Scottish Government. The New Mental Health Act: A Guide to Compulsory Treatment Orders. Scottish Government, 2008.
13 Woolley, S. Involuntary treatment in the community: role of community treatment orders. Psychiatrist 2010; 34: 441–6.
14 Department of Health. Mental Health Bill Regulatory Impact Assessment Revised Version. Department of Health, 2007.
15 King's Fund. A Question of Numbers, The Potential Impact of Community-Based Treatment Orders in England and Wales. King's Fund, 2005.
16 Manning, C, Molodynski, A, Rugkåsa, J, Dawson, J, Burns, T. Community treatment orders in England and Wales: national survey of clinicians' views and use. Psychiatrist 2011; 35: 328–33.
17 Dawson, J, Mullen, R. Insight and community treatment orders. J Ment Health 2008; 17: 269–80.
18 Department of Health. National Service Framework for Mental Health: Modern Standards and Service Models. Department of Health, 1999.
19 Department of Health. Mental Health Policy Implementation Guide: Assertive Community Treatment Teams. Department of Health, 2001.
20 Marshall, M, Lockwood, A. Assertive community treatment for people with severe mental disorders. Cochrane Database Syst Rev 1998; 2: CD001089.
21 Killaspy, H, Bebbington, P, Blizard, R, Johnson, S, Nolan, F, Pilling, S, et al. The REACT study: randomised evaluation of assertive community treatment in north London. BMJ 2006; 332: 815–20.
22 Killaspy, H, Kingett, S, Bebbington, P, Blizard, R, Johnson, S, Nolan, F, et al. Randomised evaluation of assertive community treatment: 3-year outcomes. Br J Psychiatry 2009; 195: 81–2.
23 Burns, T. End of the road for treatment-as-usual studies? Br J Psychiatry 2009; 195: 56.
24 Wright, C, Burns, T, James, P, Billings, J, Johnson, S, Muijen, M, et al. Assertive outreach teams in London: models of operation. Pan-London Assertive Outreach Study, Part I. Br J Psychiatry 2003; 183: 132–8.
25 Evans, R, Makala, J, Humphreys, M, Mohan, CRN. Supervised community treatment in Birmingham and Solihull: first 6 months. Psychiatrist 2010; 34: 330–3.
26 Hiday, VA, Swartz, MS, Swanson, JW, Borum, R, Wagner, HR. Criminal victimization of persons with severe mental illness. Psychiatr Serv 1999; 50: 62–8.
27 Steadman, HJ, Gounis, K, Dennis, D, Hopper, K, Roche, B, Swartz, M, et al. Assessing the New York City involuntary outpatient commitment pilot program. Psychiatr Serv 2001; 52: 330–6.
28 Swartz, MS, Swanson, JW, Wagner, HR, Burns, BJ, Hiday, VA, Borum, R. Can involuntary outpatient commitment reduce hospital recidivism? Findings from a randomized trial with severely mentally ill individuals. Am J Psychiatry 1999; 156: 1968–75.
29 Lambert, TJ, Singh, BS, Patel, MX. Community treatment orders and antipsychotic long-acting injections. Br J Psychiatry 2009; 195 (suppl 52): s5762.
30 Burns, T, Creed, F, Fahy, T, Thompson, S, Tyrer, P, White, I. Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet 1999; 353: 2185–9.
31 Dye, S, Dannaram, S, Loynes, B, Dickenson, R. Supervised community treatment: 2-year follow-up study in Suffolk. Psychiatrist 2012; 36: 298302.
32 Tasmanian Qualification Authority (TQA). Victorian Patient Satisfaction Monitor, Annual Survey Report, Year Three, 1 September 2002–31 August 2003. TQA, 2004 (http://www.health.vic.gov.au/patsat/).
33 Gibbs, A, Dawson, J, Ansley, C, Mullen, R. How patients in New Zealand view community treatment orders. J Ment Health 2005; 14: 357–68.
34 Lawton-Smith, S, Dawson, J, Burns, T. Community treatment orders are not a good thing. Br J Psychiatry 2008; 193: 96100.
35 O'Reilly, RL, Keegan, DL, Corring, D, Shrikhande, S, Natarajan, D. A qualitative analysis of the use of community treatment orders in Saskatchewan. Int J Law Psychiatr 2006; 29: 516–24.
36 Gibbs, A, Dawson, J, Mullen, R. Community treatment orders for people with serious mental illness: a New Zealand study. Br J Soc Work 2006; 36: 1085–100.
37 Romans, S, Dawson, J, Mullen, R, Gibbs, A. How mental health clinicians view community treatment orders: a national New Zealand survey. Aust N Z J Psychiatry 2004; 38: 836–41.
38 Freckelton, I, Lesser, J. Detention, decisions and dilemmas: reviewing involuntary detention and treatment into the 21st Century. Psychiatr Psychol Law 2003; 10: 45.
39 McDonnell, D, Bartholomew, T. Community treatment orders in Victoria: emergent issues and anomalies. Psychiatr Psychol Law 1997; 4: 2536.
40 Jaworoswski, S, Guneva, R. Community treatment orders: clinical versus administrative role. Australas Psychiatry 1999; 7: 341.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 2053-4868
  • EISSN: 2053-4876
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 9 *
Loading metrics...

Abstract views

Total abstract views: 84 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 17th July 2018. This data will be updated every 24 hours.

Use of community treatment orders in an inner-London assertive outreach service

  • Muffazal Rawala (a1) and Susham Gupta (a2)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *