A systematic review of the effect of community treatment orders on service use
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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Studies that used matched controls have reported more mixed results.
“Studies that used matched controls have reported more mixed results (Maughan 2014).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Maughan 2014
Uncontrolled before and after studies generally reported more positive outcomes than controlled before and after or randomised controlled trial designs.
“UBA studies generally reported more positive outcomes than CBA or RCT designs.”
From The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses (2024) · cites this paper as Maughan et al. (2014)
All three sibling papers concluded that there was no robust evidence about either the positive or negative effects of community treatment orders on key outcomes, including hospital readmission, length of hospital stay, or patients' quality of life.
“All three papers concluded that there was no robust evidence about either the positive or negative effects of CTOs on key outcomes, including hospital readmission, length of hospital stay, or patients’ quality of life.”
From The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses (2024) · cites this paper as Maughan et al. (2014)
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Community treatment orders should be introduced in the Republic of Ireland
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- Authors
- Maughan, D., Molodynski, A., Rugkåsa, J., & Burns, T.
- Affiliations
- Oxford Health NHS Foundation Trust (GB)
- Akershus University Hospital (NO)
- Corresponding author
- Maughan, Daniel
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2013-10-18
- Volume
- 49
- Issue
- 4
- Pages
- 651-663
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- OpenAlex
- W2085305667
- Cited by
- 106
- References
- 44
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 7 · 2023: 5 · 2022: 3 · 2021: 4 · 2020: 9 · 2019: 9 · 2018: 12 · 2017: 14 · 2016: 19 · 2015: 8 · 2014: 10
- FWCI
- 1.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (RP-PG-0606-1006)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- community treatment orders, psychiatric hospital admissions, inpatient days, medication adherence, community contacts
- MeSH terms
- Mental Disorders, Commitment of Persons with Psychiatric Disorders, Community Mental Health Services, Hospitalization, Humans, Antipsychotic Agents, Victoria, Treatment Outcome, Medication Adherence
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