Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial
Open accessAbstract
Background Compulsory supervision outside hospital has been developed internationally for the treatment of mentally ill people following widespread deinstitutionalisation but its efficacy has not yet been proven. Community treatment orders (CTOs) for psychiatric patients became available in England and Wales in 2008. We tested whether CTOs reduce admissions compared with use of Section 17 leave when patients in both groups receive equivalent levels of clinical contact but different lengths of compulsory supervision.Methods OCTET is a non-blinded, parallel-arm randomised controlled trial. We postulated that patients with a diagnosis of psychosis discharged from hospital on CTOs would have a lower rate of readmission over 12 months than those discharged on the pre-existing Section 17 leave of absence. Eligible patients were those involuntarily admitted to hospital with a diagnosis of psychosis, aged 18-65 years, who were deemed suitable for supervised outpatient care by their clinicians. Consenting patients were randomly assigned (1:1 ratio) to be discharged from hospital either on CTO or Section 17 leave. Randomisation used random permuted blocks with lengths of two, four, and six, and stratified for sex, schizophrenic diagnosis, and duration of illness. Research assistants, treating clinicians, and patients were aware of assignment to randomisation group. The primary outcome measure was whether or not the patient was admitted to hospital during the 12-month follow-up period, analysed with a log-binomial regression model adjusted for stratification factors. We did all analyses by intention to treat. This trial is registered, number ISRCTN73110773.Findings Of 442 patients assessed, 336 patients were randomly assigned to be discharged from hospital either on CTO (167 patients) or Section 17 leave (169 patients). One patient withdrew directly after randomisation and two were ineligible, giving a total sample of 333 patients (166 in the CTO group and 167 in the Section 17 group). At 12 months, despite the fact that the length of initial compulsory outpatient treatment differed significantly between the two groups (median 183 days CTO group vs 8 days Section 17 group, p<0·001) the number of patients readmitted did not differ between groups (59 [36%] of 166 patients in the CTO group vs 60 [36%] of 167 patients in the Section 17 group; adjusted relative risk 1·0 [95% CI 0·75-1·33]).Interpretation In well coordinated mental health services the imposition of compulsory supervision does not reduce the rate of readmission of psychotic patients. We found no support in terms of any reduction in overall hospital admission to justify the significant curtailment of patients' personal liberty.Funding National Institute of Health Research.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Only one study reported on outcomes at 36 months' follow-up.
“Only one study reported on outcomes at 36 months' follow-up (Burns 2013)”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Statistical analysis section defines the trial’s follow-up period as 12 months, and the Results report outcomes at 12 months. The cited paper therefore reports 12-month outcomes, not outcomes at the claimed 36-month follow-up; it also cannot establish how many other studies reported 36-month outcomes. Page numbers were not available in our copy. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn Burns 2013's non-randomised comparison, participants who were on CTOs for between six and 12 months did better than participants with other durations of CTOs (less than six months, 12 to 24 months and 24 to 36 months).
“although participants who were on CTOs for between six and 12 months did better than participants with other durations of CTOs (less than six months, 12 to 24 months and 24 to 36 months).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Split into 2 atoms — 0 confirmed, 0 partially supported, 1 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredBurns 2013 followed up all but three people included in their original intention-to-treat analysis (total n = 330).
“The authors were able to follow-up all but three people who had been included in their original intention-to-treat analysis (total n = 330).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results (page not available in our copy) say that one person withdrew and two were found ineligible immediately after randomisation. The intention-to-treat analysis included 333 people, and primary-outcome data were available for all 333—not 330 of them. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn Burns 2013's non-randomised comparison at 36-month follow-up, people who had experienced a CTO had significantly more readmissions than those who had not (IDR 1.39, 95% CI 1.07 to 1.79).
“People who had experienced a CTO had significantly more readmissions than those who had not (IDR 1.39, 95% CI 1.07 to 1.79) but otherwise there were no clear differences between groups in readmission rates, duration of readmission or time to first readmission.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results and Statistical analysis sections describe a randomised trial with 12-month follow-up, not a non-randomised comparison at 36 months. The outcomes table reports no significant difference in the number of readmissions (IDR 0.82, 95% CI 0.58–1.16), contrary to the attributed IDR of 1.39. Page numbers are not available in our copy. (LLM, conf=0.89)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn Burns 2013's non-randomised comparison, there was no linear relationship between readmission outcomes and duration of CTO.
“In addition, they did not identify a linear relationship between readmission outcomes and duration of CTO although participants who were on CTOs for between six and 12 months did better than participants with other durations of CTOs (less than six months, 12 to 24 months and 24 to 36 months).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results describe a randomised comparison of CTO and Section 17 groups, contrary to the claim that Burns 2013 made a non-randomised comparison. The Statistical analysis section specifies 12-month follow-up, and the reported results do not compare readmissions across CTO-duration categories or assess a linear relationship with duration; they cannot establish the claimed six-to-12-month advantage over categories extending to 36 months. Page numbers are not available in our copy. (LLM, conf=0.84)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured
One study included 36-month follow-up data.
“One study included 36-month follow-up data (Burns 2013).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Statistical analysis section defines the trial’s follow-up period as 12 months, and its outcome table is labeled “Outcomes at 12-month follow up.” The Results section likewise reports outcomes at 12 months, not 36 months. Page numbers were not available in our copy. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredFor readmission to hospital by 36 months, community treatment orders compared with supervised discharge (Section 17) were associated with an odds ratio of 0.71 (95% CI 0.45 to 1.11; P=0.14) in Burns 2013.
“| Burns 2013 | 100/165 | 113/165 | | 100% | 0.71[0.45,1.11] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Abstract and Results report readmission at 12 months, not 36 months: 59/166 patients on community treatment orders and 60/167 on Section 17 leave. The outcomes table gives an adjusted relative risk of 1.00 (95% CI 0.75–1.33), not the attributed odds ratio of 0.71. Page numbers are not available in our copy. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn the comparison of CTOs versus supervised discharge (Section 17), there was no clear difference in readmission to hospital by 12-month follow-up (RR 0.99, 95% CI 0.74 to 1.32).
“There was no clear difference between CTOs and Section 17 by 12month follow-up in readmission to hospital by 12-month follow-up (RR 0.99, 95% CI 0.74 to 1.32, Analysis 2.1).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Abstract and Results report no difference in hospital readmission at 12 months: 59 of 166 CTO patients and 60 of 167 Section 17 patients were readmitted. The paper reports an adjusted relative risk of 1.00 (95% CI 0.75–1.33), not the quoted 0.99 (0.74–1.32); the latter is consistent with an unadjusted calculation from its event counts. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus supervised discharge, there was no clear difference in hospital bed-days by 12-month follow-up (MD -8.70, 95% CI -30.88 to 13.48).
“There was no clear difference between CTOs and Section 17 in hospital bed-days by 12-month follow-up (MD -8.70, 95% CI -30.88 to 13.48, Analysis 2.3).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Table 2 (Statistical analysis; page unavailable) reports mean hospitalisation durations of 82.2 nights for CTOs and 90.9 for Section 17, a difference of −8.7 nights. The Results state that days in hospital did not differ at 12 months, but our copy does not report the claimed mean-difference confidence interval; Table 2 instead gives an incident-density ratio of 0.90 (95% CI 0.65–1.26). (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe additional analyses in Burns 2013 were not adjusted for potential confounders because participants in the two groups were not randomly allocated.
“However, the major drawback of these analyses was that they were not adjusted for potential confounders given that participants in these two groups were not randomly allocated.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Statistical analysis section (page unavailable) says the sensitivity analyses were unadjusted for stratification factors, and the Results section says one such analysis excluded participants who did not receive their assigned treatment. But the paper says participants were initially randomly assigned; it does not state that lack of random allocation was the reason the additional analyses were unadjusted for potential confounders. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus supervised discharge at 36 months, there was no clear difference in readmission to hospital (RR 0.71, 95% CI 0.45 to 1.11).
“There were no clear differences between participants originally randomised to CTO or Section 17 in terms of readmission to hospital (RR 0.71, 95% CI 0.45 to 1.11, Analysis 2.2)”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results and Table 2 (page not available in our copy) report no clear difference in readmission between the CTO and Section 17 groups, but only at 12 months. The reported adjusted RR is 1.00 (95% CI 0.75–1.33), not 0.71 (0.45–1.11); our copy does not report a 36-month comparison. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus standard care encompassing both voluntary care and supervised discharge, there was no clear difference in readmission to hospital by 12 months (RR 0.98, 95% CI 0.83 to 1.17).
“There was no clear difference between participants on CTOs and controls in readmission to hospital by 12 months (RR 0.98, 95% CI 0.83 to 1.17, Analysis 3.1).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results and Abstract report no difference in hospital readmission at 12 months, but the trial compared CTOs with Section 17 leave, not a control group encompassing both voluntary care and supervised discharge. The paper reports an adjusted relative risk of 1.00 (95% CI 0.75–1.33), not 0.98 (0.83–1.17). (LLM, conf=0.92)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus supervised discharge, there was no clear difference in BPRS scores at 12-month follow-up (MD -0.10, 95% CI -3.17 to 2.97).
“There was no clear difference between CTOs and Section 17 in BPRS scores at 12-month follow-up (MD -0.10, 95% CI -3.17 to 2.97, Analysis 2.8).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results state that BPRS symptoms did not differ between the CTO and Section 17 groups at 12 months. However, Table 2 reports an adjusted mean difference of −1.09 (95% CI −3.25 to 1.07), not the cited MD of −0.10 (95% CI −3.17 to 2.97). (LLM, conf=0.92)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus standard care, there was no difference in global state (GAF) at follow-up (MD -1.36, 95% CI -4.07 to 1.35).
“At follow-up, there was no difference between people allocated to CTOs and controls in global state (GAF) (MD -1.36 95% CI -4.07 to 1.35, Analysis 3.4).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results report no difference in GAF between the CTO and Section 17 groups at 12 months. However, Table 2 (displayed under Statistical analysis; page not available) gives an adjusted mean difference of -0.86 (95% CI -2.93 to 1.20), not the cited -1.36 (95% CI -4.07 to 1.35). (LLM, conf=0.92)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus supervised discharge, there was no clear difference in number of readmissions by 12-month follow-up (MD -0.20, 95% CI -0.45 to 0.05).
“There was no clear difference between CTOs and Section 17 in number of readmissions by 12-month follow-up (MD -0.20, 95% CI -0.45 to 0.05, Analysis 2.4).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results report no difference in the number of readmissions at 12 months. The outcome table gives means of 1.2 for CTO and 1.4 for Section 17, consistent with a difference of −0.20, but reports an incident-density ratio of 0.82 (95% CI 0.58–1.16), not the claimed mean-difference confidence interval. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus supervised discharge at 36 months, there was no clear difference in numbers with multiple readmissions (RR 1.07, 95% CI 0.62 to 1.85).
“numbers with multiple readmissions (RR 1.07, 95% CI 0.62 to 1.85, Analysis 2.2)”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results report no clear difference in readmissions between CTO and Section 17 leave groups, and Table 2 records the numbers with multiple readmissions. But these are 12-month results (10/166 versus 18/167), not a 36-month comparison; the paper does not report the claimed RR 1.07 (95% CI 0.62–1.85). (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus standard care, there was no clear difference in bed-days by 12 months (MD -3.35, 95% CI -15.14 to 8.44).
“There was no clear difference between participants on CTOs and controls in bed-days by 12 months (MD -3.35, 95% CI -15.14 to 8.44, Analysis 3.2).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results state that days in hospital did not differ between the CTO and Section 17 leave groups at 12 months. Table 2 reports hospitalisation nights and an incident-density ratio of 0.90 (95% CI 0.65–1.26), but not the claimed mean difference of −3.35 or its confidence interval. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus standard care, there was no clear statistical difference in the number of people who required more than one readmission by 12 months (RR 1.02, 95% CI 0.31 to 3.33).
“There was no clear (statistical) difference in the number of people who required more than one readmission by 12 months (RR 1.02, 95% CI 0.31 to 3.33, Analysis 3.3).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results report no significant difference in hospital admissions over 12 months, and the outcome table lists 10 of 166 CTO patients versus 18 of 167 Section 17 patients with multiple readmissions. The paper does not report the claimed RR of 1.02 or 95% CI of 0.31–3.33 for that outcome; its comparator was Section 17 leave, not described here as standard care. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn Burns 2013's non-randomised comparison, there were no clear differences between groups in readmission rates, duration of readmission or time to first readmission.
“but otherwise there were no clear differences between groups in readmission rates, duration of readmission or time to first readmission.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results and Discussion report no clear differences between groups in readmission, time to readmission, or duration of hospital admissions. However, the Results say patients were randomly assigned to the two groups; calling this a non-randomised comparison is incorrect. Page numbers were not provided in our copy. (LLM, conf=0.91)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus supervised discharge, scores on the Objective Social Outcomes Index were almost identical (MD -0.10, 95% CI -0.40 to 0.20).
“For example, the scores on the Objective Social Outcomes Index were almost identical (MD-0.10 95% CI -0.40 to 0.20, Analysis 2.12).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results and Discussion report no difference in social outcomes between the CTO and Section 17 groups. But the Statistical analysis section says social outcome was measured with the Global Assessment of Functioning (GAF), and its table reports an adjusted mean difference of −0.86 (95% CI −2.93 to 1.20). Our copy does not report an Objective Social Outcomes Index score or the quoted mean difference and confidence interval. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus supervised discharge at 36 months, there was no clear difference in bed-days (MD -15.10, 95% CI -89.39 to 59.19).
“or bed-days (MD -15.10, 95% CI -89.39 to 59.19, Analysis 2.7).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results report no difference in days spent in hospital between the CTO and Section 17 groups, and Table 2 reports hospitalisation nights at 12 months. The paper does not report a 36-month comparison or the stated mean difference and confidence interval; its reported effect measure for hospitalisation nights is an incident-density ratio. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA sensitivity analysis including the 167 CTO cases and 169 controls who were randomised did not alter the results.
“As a precaution, we undertook sensitivity analyses of the effect of including the 167 CTO cases and 169 controls who were randomised and, again, this did not alter the results.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results section confirms that 167 CTO patients and 169 Section 17 controls were randomised. It reports outcomes for 333 patients and says a sensitivity analysis excluding certain protocol deviations gave similar results; it does not report a sensitivity analysis including all 336 randomised patients. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus supervised discharge at 36 months, there was no clear difference in days in community to first admission (MD 60.00, 95% CI -27.62 to 147.62).
“days in community to first admission (MD 60.00, 95% CI -27.62 to 147.62, Analysis 2.7)”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Statistical analysis table (Table 2, page not provided) reports no clear difference in days in the community until first readmission between CTO and Section 17 groups (p=0.755). But it reports outcomes at 12 months, not 36 months, and does not give the claimed mean difference of 60.00 or its confidence interval. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe third trial, from the UK, was a study of clinician-initiated rather than court-ordered treatment and is thus more relevant to other jurisdictions such as Australia, Canada and New Zealand.
“The third trial, from the UK, was a study of clinician-initiated, rather than court-ordered, treatment as in the US RCTs and thus, more relevant to other jurisdictions such as Australia, Canada and New Zealand.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Introduction identifies OCTET as the third randomised CTO trial and places it in England and Wales; the Procedures say a CTO is initiated when a responsible clinician and an approved mental health practitioner deem supervision necessary. The paper identifies the earlier trials as US studies, but the passages do not establish that those trials were court-ordered. The claim about greater relevance to Australia, Canada and New Zealand is the citing authors’ inference. (LLM, conf=0.85)
Experimental — accuracy not yet measuredA sensitivity analysis to remove protocol violations in Burns 2013 may have left the study underpowered and did not remove the possibility that Section 17 participants swapped to a CTO might have been more severely ill than participants remaining on Section 17 as per the protocol.
“A sensitivity analysis to remove these protocol violations may, in turn, have left the study underpowered and not removed the possibility that Section 17 participants swapped to a CTO might have been more severely ill than participants remaining on Section 17 as per the protocol.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredA final issue in Burns 2013 was generalisability: around 20% of the sample were ineligible or refused to take part, and these participants may have been the most unwell or lacking in insight, and therefore the ones most likely to benefit from CTOs.
“A final issue was generalisability. Around 20% of the sample were ineligible or refused to take part. These participants may have been the most unwell or lacking in insight, and therefore the ones most likely to benefit from CTOs.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn Burns 2013, length of initial compulsory outpatient treatment differed widely between the two groups (medians of 183 days with CCT versus 8 days with supervised discharge), but Section 17 participants averaged 4 months on some form of compulsory treatment over the 12 months, consisting of the mean of 8 days on Section 17 plus periods of compulsory care during follow-up.
“Although length of initial compulsory outpatient treatment differed widely between the 2 groups (medians of 183 days with CCT versus 8 days with supervised discharge), Section 17 participants averaged 4 months on some form of compulsory treatment over the 12 months consisting of the mean of 8 days on Section 17 plus periods of compulsory care during follow-up (outcome).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredAnother potential source of bias in Burns 2013 was that clinicians could keep participants on Section 17 for a variable period of time, and it is possible that participants most likely to default on treatment were maintained on Section 17, where it acted more like a CTO, thus reducing the chance of the study finding an effect of CTOs.
“Another potential source of bias was that clinicians could keep participants on Section 17 for a variable period of time. It is possible that participants who were most likely to default on treatment were maintained on Section 17 and that for these participants it acted more like a CTO thus reducing the chance of the study finding an effect of CTOs.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredFor more than one readmission by 36 months, community treatment orders compared with supervised discharge (Section 17) were associated with an odds ratio of 1.07 (95% CI 0.62 to 1.85; P=0.81) in Burns 2013.
“| Burns 2013 | 60/100 | 66/113 | | 100% | 1.07[0.62,1.85] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Statistical analysis section’s Table 2 reports multiple readmissions for the CTO and Section 17 groups, but at 12 months: 10/166 and 18/167, respectively. The paper does not report the claimed 36-month counts, odds ratio, confidence interval, or P value. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor community treatment orders compared with supervised discharge, mean duration of bed-days did not differ significantly (mean difference -15.1 days, 95% CI -89.39 to 59.19; Z=0.4, P=0.69; 100 vs 112 participants; Burns 2013).
“Burns 2013 | 100 | | | (282.5) | |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results report no significant difference in days spent in hospital between the CTO and Section 17 groups. Table 2 (Statistical analysis; page unavailable) reports 166 versus 167 participants and an incident-density ratio of 0.90 (95% CI 0.65–1.26), not the claimed 100 versus 112 participants or the stated mean difference, CI, Z statistic, and P value. (LLM, conf=0.90)
Experimental — accuracy not yet measuredFor compulsory community treatment compared with standard care, number with multiple readmissions by 12 months did not differ significantly (risk ratio 1.02, 95% CI 0.31 to 3.33; 2 studies, 485 participants; Burns 2013, Steadman 2001).
“3 Health service outcomes: 3. Number with multiple readmissions by 12 months | 2 | 485 | Risk Ratio (M-H, Random, 95% CI) | 1.02 [0.31, 3.33]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredFor number of readmissions by 12 months, community treatment orders compared with supervised discharge (Section 17) were associated with a mean difference of -0.20 (95% CI -0.45 to 0.05; P=0.12) in Burns 2013.
“| Burns 2013 | 59 | 1.2 (0.6) | 60 | 1.4 (0.8) | | 100% | | -0.2[-0.45,0.05] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The outcome table in the Statistical analysis passage reports 59 CTO patients with 1.2 (0.6) readmissions and 60 Section 17 patients with 1.4 (0.8), supporting a difference of −0.20 at 12 months. It does not report the claimed confidence interval or P value for that mean difference; it reports an incident density ratio of 0.82 (95% CI 0.58–1.16) instead. (LLM, conf=0.87)
Experimental — accuracy not yet measuredFor community treatment orders compared with supervised discharge (Section 17), time to first readmission in days did not differ significantly (mean difference 60 days, 95% CI -27.62 to 147.62; Z=1.34, P=0.18; 165 vs 165 participants; Burns 2013).
“Burns 2013 | 165 | 571.4 (410.4) | 165 | 511.4 (401.7) | | | | 100% | 60[-27.62,147.62]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredFor community treatment orders compared with supervised discharge, global state (GAF) at 12 months did not differ significantly (mean difference -0.7, 95% CI -3.91 to 2.51; Z=0.43, P=0.67; 123 vs 114 participants; Burns 2013).
“Burns 2013 | 123 | 39 (12) | 114 | 39.7 (13.1) | | | 100% | -0.7[-3.91,2.51]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Table 2 reports GAF scores at 12 months for 123 CTO participants (39.0, SD 12.0) and 114 Section 17 participants (39.7, SD 13.1); the Results state that GAF did not differ between groups. The cited −0.7 difference follows from those group means, but the paper reports an adjusted mean difference of −0.86 (95% CI −2.93 to 1.20), not the claimed confidence interval, Z statistic, or P value. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor mean duration of bed-days by 36 months, community treatment orders compared with supervised discharge (Section 17) were associated with a mean difference of -15.10 (95% CI -89.39 to 59.19).
“| 7.2 Mean duration of bed-days | 1 | 212 | Mean Difference (IV, Fixed, 95% CI) | -15.10 [-89.39, 59.19] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Table 2 (Statistical analysis; page unavailable) compares hospitalisation nights for the CTO and Section 17 groups, so the source supports the outcome and comparison. But it reports 12-month follow-up, with means of 82.2 and 90.9 nights and an incident-density ratio of 0.90 (95% CI 0.65–1.26), not the claimed 36-month mean difference of -15.10 (95% CI -89.39 to 59.19). (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor compulsory community treatment compared with standard care, hospital bed-days did not differ significantly (mean difference -3.35, 95% CI -15.14 to 8.44; 2 studies, 597 participants; Burns 2013, Swartz 1999).
“2 Health service outcomes: 2. Hospital bed-days | 2 | 597 | Mean Difference (IV, Fixed, 95% CI) | -3.35 [-15.14, 8.44]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredFor community treatment orders compared with supervised discharge, Social Outcomes Index at 12 months did not differ significantly (mean difference -0.1, 95% CI -0.4 to 0.2; Z=0.66, P=0.51; 123 vs 113 participants; Burns 2013).
“Burns 2013 | 123 | 2.6 (1) | 113 | 2.7 (1.3) | | 100% | -0.1[-0.4,0.2]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results report no significant difference in social functioning at 12 months. But Table 2 measures this with the Global Assessment of Functioning, not a Social Outcomes Index, and reports 123 versus 114 participants and an adjusted mean difference of -0.86 (95% CI -2.93 to 1.20). It does not report the claimed Z statistic or P value for that outcome. (LLM, conf=0.92)
Experimental — accuracy not yet measuredFor community treatment orders compared with supervised discharge, psychiatric symptoms at 12 months (BPRS) did not differ significantly (mean difference -0.1, 95% CI -3.17 to 2.97; Z=0.06, P=0.95; 122 vs 112 participants; Burns 2013).
“Burns 2013 | 122 | 38.2 (11.5) | 112 | 38.3 (12.4) | | | 100% | -0.1[-3.17,2.97]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredFor days in community till first admission by 12 months, community treatment orders compared with supervised discharge (Section 17) were associated with a mean difference of 5.0 (95% CI -21.74 to 31.74; P=0.71) in Burns 2013.
“| Burns 2013 | 166 | 246 (122.4) | 167 | 241 (126.5) | | | | 100% | 5[-21.74,31.74] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Table 2 (Statistical analysis section; page not supplied) reports 246 (SD 122.4) days for 166 CTO patients and 241 (SD 126.5) for 167 Section 17 patients, supporting the stated 5-day difference between means. It does not report the quoted 95% CI or P=0.71 for this outcome; its reported Wilcoxon rank-sum P value is 0.755. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor readmission to hospital by 12 months, community treatment orders compared with supervised discharge (Section 17) were associated with a risk ratio of 0.99 (95% CI 0.74 to 1.32; P=0.94) in Burns 2013.
“| Burns 2013 | 59/166 | 60/167 | | 100% | 0.99[0.74,1.32] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Abstract and Table 2 report 12-month readmissions of 59/166 for CTO and 60/167 for Section 17, supporting the comparison and the citing table’s counts. The Statistical analysis section reports an adjusted relative risk of 1.00 (95% CI 0.75–1.33), not the cited 0.99 (0.74–1.32); the cited P=0.94 is not reported in these passages. The differing figures may reflect a calculation from the reported counts, but they are not the paper’s reported estimate. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor compulsory community treatment compared with standard care, global state (GAF) at 12 months did not differ significantly (mean difference -1.36, 95% CI -4.07 to 1.35; 2 studies, 335 participants; Burns 2013, Steadman 2001).
“4 Participant level outcomes: 1. global state: GAF at 12 months | 2 | 335 | Mean Difference (IV, Fixed, 95% CI) | -1.36 [-4.07, 1.35]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results and Table 2 report no significant difference in GAF at 12 months between the CTO and Section 17 groups. Burns 2013 reports an adjusted mean difference of −0.86 (95% CI −2.93 to 1.20) for 237 participants with GAF data; it does not report the claimed pooled estimate from two studies and 335 participants. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor Social Outcomes Index at 12 months, community treatment orders compared with supervised discharge (Section 17) were associated with a mean difference of -0.10 (95% CI -0.40 to 0.20).
“| 12 Participant level outcomes: 5. Social Out- comes Index at 12 months | 1 | 236 | Mean Difference (IV, Fixed, 95% CI) | -0.10 [-0.40, 0.20] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results report no difference in social functioning between the CTO and Section 17 groups at 12 months. However, the paper measures this using the Global Assessment of Functioning, not a Social Outcomes Index; its outcome table reports an adjusted mean difference of −0.86 (95% CI −2.93 to 1.20) for 237 participants, not −0.10 (−0.40 to 0.20) for 236. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor time to first readmission in days by 36 months, community treatment orders compared with supervised discharge (Section 17) were associated with a mean difference of 60.0 (95% CI -27.62 to 147.62).
“| 7.1 Time to 1st readmission in days | 1 | 330 | Mean Difference (IV, Fixed, 95% CI) | 60.0 [-27.62, 147.62] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Abstract and Statistical analysis section (pages not specified in our copy) confirm that the trial compared community treatment orders with Section 17 leave and measured time to first readmission. But it followed patients for 12 months, not 36; the reported mean days until first readmission were 246 versus 241, and the paper does not report a mean difference of 60.0 days or the stated confidence interval. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor compulsory community treatment compared with standard care, readmission to hospital by 11 to 12 months did not differ significantly (risk ratio 0.98, 95% CI 0.83 to 1.17; 3 studies, 749 participants; Burns 2013, Steadman 2001, Swartz 1999).
“1 Health service outcomes: 1. Readmission to hospi- tal by 11 to 12 months | 3 | 749 | Risk Ratio (M-H, Fixed, 95% CI) | 0.98 [0.83, 1.17]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results report no difference in readmission at 12 months: 59 of 166 CTO patients and 60 of 167 Section 17 patients were readmitted. Burns 2013 is one of the three trials named in the claim, but its own estimate is an adjusted relative risk of 1.00 (95% CI 0.75–1.33) in 333 patients; it does not report the pooled estimate of 0.98 (0.83–1.17) across 749 participants. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor hospital bed-days by 12 months, community treatment orders compared with supervised discharge (Section 17) were associated with a mean difference of -8.70 (95% CI -30.88 to 13.48; P=0.44) in Burns 2013.
“| Burns 2013 | 166 | 82.2 (102) | 167 | 90.9 (104.5) | | 100% | | -8.7[-30.88,13.48] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The trial’s outcome table (indexed under Statistical analysis; page unavailable) reports 82.2 nights (SD 102.0) for 166 CTO patients and 90.9 nights (SD 104.5) for 167 Section 17 patients, yielding the stated mean difference of −8.7. It does not report the claimed mean-difference confidence interval or P=0.44; its reported treatment effect for this outcome is an incident-density ratio. (LLM, conf=0.86)
Experimental — accuracy not yet measuredFor compulsory community treatment compared with standard care, satisfaction with care (perceived coercion or leverage) at 11 to 12 months did not differ significantly (risk ratio 1.30, 95% CI 0.98 to 1.71; 3 studies, 645 participants; Swartz 1999, Steadman 2001, Burns 2013).
“5 Participant level outcomes: 2. Satisfaction with care: perceived coercion or leverage at 11 to 12 months | 3 | 645 | Risk Ratio (M-H, Fixed, 95% CI) | 1.30 [0.98, 1.71]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThere was uncertainty concerning the control condition within OCTET.
“There was also uncertainty concerning the control condition within OCTET (Burns 2013).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Two studies were identified in the original 2003 search and the third in the 2014 search.
“Two of the studies were identified in the original search of 2003 (Swartz 1999; Steadman 2001) and the third in the 2014 search (Burns 2013).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
One potential source of bias in OCTET was that participants were only included if they were thought to be equally suitable for a relatively short Section 17 or CTO.
“One potential source of bias in the OCTET study was that participants were only included if they were thought to be equally suitable for a relatively short Section 17 or CTO (Burns 2013).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
One included study was a UK study (OCTET) comparing two types of CCT interspaced with voluntary care.
“We included three studies involving 749 participants: two studies from the USA comparing OPC with entirely voluntary treatment (Swartz 1999; Steadman 2001), and one UK study, the Oxford Community Treatment Order Evaluation Trial (OCTET), comparing two types of CCT interspaced with voluntary care (Burns 2013).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Around 20% of participants were ineligible or refused to take part in OCTET.
“In addition, around 20% of the participants were ineligible or refused to take part in OCTET (Burns 2013).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
In OCTET, 35 participants randomised to CTOs (22%) did not actually receive the intervention.
“A second potential source of bias in the OCTET study was allowing clinicians to make decisions independent of initial randomisation whereby 40 participants (25%) allocated to Section 17 were subsequently placed on a CTO during the study and 35 participants randomised to CTOs (22%) did not actually receive the intervention (Burns 2013).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
In OCTET, 40 participants (25%) allocated to Section 17 were subsequently placed on a CTO during the study.
“A second potential source of bias in the OCTET study was allowing clinicians to make decisions independent of initial randomisation whereby 40 participants (25%) allocated to Section 17 were subsequently placed on a CTO during the study and 35 participants randomised to CTOs (22%) did not actually receive the intervention (Burns 2013).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Burns 2013 involved allocation to two different types of legal status, making masking impossible and unlawful.
“Burns 2013 involved allocation to two different types of legal status. Therefore, it was both impossible and unlawful to mask research assistants, treating clinicians or participants, thus we rated this as high risk.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
A third potential source of bias in OCTET was that clinicians could keep participants on Section 17 for a variable period of time.
“A third potential source of bias in the OCTET study was that clinicians could keep participants on Section 17 for a variable period of time (Burns 2013).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Burns 2013 stated they used an intention-to-treat analysis in 166 CTO cases and 167 controls.
“The authors of the Burns 2013 study stated they used an intention-to-treat analysis in 166 CTO cases and 167 controls.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The UK trial was a comparison of two different types of compulsory intervention of different durations rather than a comparison of compulsory intervention with entirely voluntary treatment.
“However, this was a comparison of two different types of compulsory intervention of different durations rather than a comparison of compulsory intervention with entirely voluntary treatment.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
In the comparison of CTOs versus supervised discharge, there was no clear difference in number with multiple readmissions by 12 months (RR 0.56, 95% CI 0.27 to 1.17).
“There was no clear difference between CTOs and Section 17 in number with multiple readmissions by 12 months (RR 0.56, 95% CI 0.27 to 1.17, Analysis 2.5).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
In the comparison of CTOs versus supervised discharge, there was no clear difference in GAF scores at 12-month follow-up (MD -0.70, 95% CI -3.91 to 2.51).
“There was no clear difference between CTOs and Section 17 in terms of GAF scores at 12-month follow-up (MD -0.70 95% CI -3.91 to 2.51, Analysis 2.9).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
In the comparison of CTOs versus supervised discharge, there was no clear difference in days in the community to first admission at 12-month follow-up (MD 5.00, 95% CI -21.74 to 31.74).
“There was no clear difference between CTOs and Section 17 in days in the community to first admission at 12-month follow-up (MD 5.00, 95% CI -21.74 to 31.74, Analysis 2.6).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
In Burns 2013, immediately after randomisation two participants were found to be ineligible and one withdrew, and these participants were not included in the intention-to-treat analysis.
“However, immediately after randomisation two participants were found to be ineligible and one withdrew. These participants were not included in the intention-to-treat analysis.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
In the OCTET study, a quarter of participants did not receive the intervention to which they were initially randomised because treating physicians were able to make clinical decisions irrespective of initial randomisation, a requirement for the trial to be lawful.
“In addition to the question around the voluntary or compulsory nature of the controls in the OCTET study, the other major issue was that a quarter of participants did not receive the intervention to which they were initially randomised. This was because treating physicians were able to make clinical decisions irrespective of initial randomisation, a requirement for the trial to be lawful.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
In the Burns 2013 study, other potential sources of bias were judged high risk because clinicians could make decisions independent of initial randomisation, with 40 participants (25%) allocated to Section 17 subsequently placed on a CTO and 35 participants randomised to CTOs (22%) not actually receiving the intervention.
“Other potential sources of bias in the study included allowing clinicians to make decisions independent of initial randomisation, whereby 40 participants (25%) allocated to Section 17 were subsequently placed on a CTO during the study and 35 participants randomised to CTOs (22%) did not actually receive”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Selective reporting (reporting bias) was judged low risk for Burns 2013, with no apparent selective reporting.
“Selective reporting (re- porting bias) | Low risk | Not apparent”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
For mental state (BPRS) at 12 months, community treatment orders compared with supervised discharge (Section 17) were associated with a mean difference of -0.10 (95% CI -3.17 to 2.97).
“| 8 Participant level outcomes: 1. Mental state - psychiatric symptoms at 12 months (BPRS) | 1 | 234 | Mean Difference (IV, Fixed, 95% CI) | -0.10 [-3.17, 2.97] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
For number with multiple readmissions by 12 months, community treatment orders compared with supervised discharge (Section 17) were associated with a risk ratio of 0.56 (95% CI 0.27 to 1.17; P=0.12) in Burns 2013.
“| Burns 2013 | 10/166 | 18/167 | 100% | 0.56[0.27,1.17] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
For global state (GAF) at 12 months, community treatment orders compared with supervised discharge (Section 17) were associated with a mean difference of -0.70 (95% CI -3.91 to 2.51).
“| 9 Participant level outcomes: 2. Global state: GAF at 12 months | 1 | 237 | Mean Difference (IV, Fixed, 95% CI) | -0.70 [-3.91, 2.51] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
Data from the new included study OCTET (Burns 2013) have not changed the overall conclusions of the review.
“Data from one new included study (OCTET - Burns 2013) have not changed the overall conclusions of this review.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
In the comparison of CTOs versus supervised discharge, there was no statistical difference in perceived coercion at 12-month follow-up (MD -0.50, 95% CI -1.71 to 0.71).
“There was no statistical difference between participants randomised to CTOs or Section 17 at 12-month follow-up (MD -0.50, 95% CI -1.71, to 0.71, Analysis 2.10).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Statistical analysis and Results sections (page not available) compare CTOs with Section 17 leave at 12 months, but report readmission, symptoms and social functioning—not perceived coercion. Searches for perceived coercion and the stated mean difference and confidence interval found no matching result in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIn the comparison of CCT versus control, participants on CCT did not feel more coerced than participants in the control group at 11 to 12 months (RR 1.30, 95% CI 0.98 to 1.71).
“This showed that participants on CCT did not feel more coerced that participants in the control group at 11 to 12 months (RR 1.30, 95% CI 0.98 to 1.71, Analysis 3.5).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results report days under legal compulsion for the CTO and Section 17 groups, but not whether participants felt coerced. Searches for perceived coercion and the stated RR and CI found no matching outcome in our copy; the trial’s reported 12-month relative risk concerns hospital readmission instead. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus supervised discharge, there was no statistical difference in experience of leverage at 11 to 12 months (OR 1.23, 95% CI 0.66 to 2.31).
“There was no statistical difference between the two treatment groups (OR 1.23 95% CI 0.66 to 2.31).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results report no difference between CTO and Section 17 groups in readmission and measured clinical outcomes at 12 months, but do not report experience of leverage. Searches for “leverage” and the stated OR and confidence interval found no matching result in our copy, so the specific comparison cannot be verified. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIn the comparison of CTOs versus supervised discharge, there was no difference between groups in alcohol or substance use, insight, psychotropic medication, experience of services and participant satisfaction as measured by standardised questionnaires.
“Finally, there was no difference between groups in terms of alcohol or substance use, insight, psychotropic medication, experience of services and participant satisfaction as measured by standardised questionnaires.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results (page unavailable) report no between-group difference in readmission, psychiatric symptoms, or social functioning; the paper also reports similar rates of clinical contact. Searches for alcohol or substance use, insight, psychotropic medication, service experience, and questionnaire-measured satisfaction found no comparison of those outcomes in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measuredFor perceived coercion at 11 to 12 months, community treatment orders compared with supervised discharge (Section 17) were associated with a mean difference of -0.5 (95% CI -1.71 to 0.71).
“| 10 Participant level outcomes: 3. Satisfac- tion with care: perceived coercion at 11 to 12 months | 1 | 182 | Mean Difference (IV, Fixed, 95% CI) | -0.5 [-1.71, 0.71] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results section compares CTOs with Section 17 leave and reports days under legal compulsion, but not perceived coercion. A search for perceived coercion and the stated mean difference and confidence interval found no matching result in our copy; the Statistical analysis section lists other 12-month outcomes instead. Page numbers were not available in the indexed passages. (LLM, conf=0.75)
Experimental — accuracy not yet measuredFor community treatment orders compared with supervised discharge, perceived coercion at 11 to 12 months did not differ significantly (mean difference -0.5, 95% CI -1.71 to 0.71; Z=0.81, P=0.42; 97 vs 85 participants; Burns 2013).
“Burns 2013 | 97 | 13.8 (4.3) | 85 | 14.3 (4) | | | 100% | -0.5[-1.71,0.71]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results report that patients in the CTO group spent significantly more days under legal compulsion, but do not report perceived coercion. Searches for perceived coercion and the cited group sizes and estimates found no matching outcome in our copy; the Statistical analysis section’s 12-month outcomes instead list clinical measures such as BPRS and GAF. (LLM, conf=0.76)
Experimental — accuracy not yet measuredFor community treatment orders compared with supervised discharge, leverage at 11 to 12 months did not differ significantly (odds ratio 1.23, 95% CI 0.66 to 2.31; Z=0.65, P=0.52; 28/119 vs 22/110; Burns 2013).
“Burns 2013 | 28/119 | 22/110 | | 100% | 1.23[0.66,2.31]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results and Statistical analysis sections report 12-month readmission, clinical outcomes, and time under compulsory supervision, but not a measure called leverage. Searches for leverage and the reported counts found no passage giving 28/119 versus 22/110 or the stated odds ratio, so our copy cannot verify this comparison. (LLM, conf=0.76)
Experimental — accuracy not yet measuredFor leverage at 11 to 12 months, community treatment orders compared with supervised discharge (Section 17) were associated with an odds ratio of 1.23 (95% CI 0.66 to 2.31).
“| 11 Participant level outcomes: 4. Satisfaction with care: leverage at 11 to 12 months | 1 | 229 | Odds Ratio (M-H, Fixed, 95% CI) | 1.23 [0.66, 2.31] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Burns 2013
The Results and Table 2 report 12-month outcomes for the CTO and Section 17 groups, but do not report leverage or an odds ratio of 1.23 (95% CI 0.66–2.31). Searches for leverage, satisfaction with care, and the stated figures found no matching result in our copy. (LLM, conf=0.73)
Experimental — accuracy not yet measuredUnlike the US studies, patients with a history of violence were not excluded in OCTET.
“Unlike the US studies, patients with a history of violence were not excluded.”
From An Updated Meta-Analysis of Randomized Controlled Evidence for the Effectiveness of Community Treatment Orders (2014) · cites this paper as [7]
In OCTET, the length of initial compulsory outpatient treatment differed significantly between the 2 groups (medians of 183 days compared with 8 days).
“Although the length of initial compulsory outpatient treatment differed significantly between the 2 groups (medians of 183 days, compared with 8 days), Section 17 patients averaged 4 months on some form of compulsory treatment over the course of the study.”
From An Updated Meta-Analysis of Randomized Controlled Evidence for the Effectiveness of Community Treatment Orders (2014) · cites this paper as [7]
OCTET was more relevant to other jurisdictions, such as Australia, Canada, and New Zealand, than the American RCTs.
“OCTET was a study of clinician-initiated, rather than court-ordered, treatment studied in the American RCTs and thus more relevant to other jurisdictions, such as Australia, Canada, and New Zealand.”
From An Updated Meta-Analysis of Randomized Controlled Evidence for the Effectiveness of Community Treatment Orders (2014) · cites this paper as [7]
Section 17 patients in OCTET averaged 4 months on some form of compulsory treatment over the course of the study.
“Although the length of initial compulsory outpatient treatment differed significantly between the 2 groups (medians of 183 days, compared with 8 days), Section 17 patients averaged 4 months on some form of compulsory treatment over the course of the study.”
From An Updated Meta-Analysis of Randomized Controlled Evidence for the Effectiveness of Community Treatment Orders (2014) · cites this paper as [7]
In OCTET, patients were only included if they were thought to be equally suitable for a relatively short Section 17 or a CTO.
“However, patients were only included if they were thought to be equally suitable for a relatively short Section 17 or a CTO.”
From An Updated Meta-Analysis of Randomized Controlled Evidence for the Effectiveness of Community Treatment Orders (2014) · cites this paper as [7]
OCTET was a study of clinician-initiated, rather than court-ordered, treatment studied in the American RCTs.
“OCTET was a study of clinician-initiated, rather than court-ordered, treatment studied in the American RCTs and thus more relevant to other jurisdictions, such as Australia, Canada, and New Zealand.”
From An Updated Meta-Analysis of Randomized Controlled Evidence for the Effectiveness of Community Treatment Orders (2014) · cites this paper as [7]
Treating clinicians in OCTET were able to make decisions independent of randomization, and around one-fifth of patients in either arm swapped treatments.
“Finally, treating clinicians were able to make decisions independent of randomization, thus around one-fifth of patients in either arm swapped treatments.”
From An Updated Meta-Analysis of Randomized Controlled Evidence for the Effectiveness of Community Treatment Orders (2014) · cites this paper as [7]
Around 20% of eligible patients in OCTET lacked capacity to consent or refused to participate.
“Further, around 20% of eligible patients lacked capacity to consent or refused to participate.”
From An Updated Meta-Analysis of Randomized Controlled Evidence for the Effectiveness of Community Treatment Orders (2014) · cites this paper as [7]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Revising axis V for DSM-IV: a review of measures of social functioning
Goldman, H. H., Skodol, A. E., & Lave, T. R. (1992) · American Journal of Psychiatry · doi:10.1176/ajp.149.9.1148 · Cited by 1,408 · see citing works
Priebe, S., Badesconyi, A., Fioritti, A., Hansson, L., Kilian, R., Torres-Gonzales, F., Turner, T., & Wiersma, D. (2005) · BMJ · doi:10.1136/bmj.38296.611215.ae · Cited by 463 · see citing works
Self-citationSwartz, M. S., Swanson, J. W., Wagner, H. R., Burns, B. J., Hiday, V. A., & Borum, R. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.12.1968 · Cited by 337 · see citing works
Compulsory community and involuntary outpatient treatment for people with severe mental disorders
Kisely, S. R., & Campbell, L. A. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004408.pub4 · Cited by 320 · see citing works
Assessing the New York City involuntary outpatient commitment pilot program
Steadman, H. J., Gounis, K., Dennis, D., Hopper, K., Roche, B., Swartz, M., & Robbins, P. C. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.3.330 · Cited by 312 · see citing works
International experiences of using community treatment orders
Churchill, R. C., Owen, G. S., Singh, S. P., & Hotopf, M. H. (2006) · PsycEXTRA Dataset · doi:10.1037/e622832007-001 · Cited by 204 · see citing works
Compulsory community and involuntary outpatient treatment for people with severe mental disorders
Kisely, S. R., Campbell, L. A., & Preston, N. J. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004408.pub3 · Cited by 133 · see citing works
Compulsory community and involuntary outpatient treatment for people with severe mental disorders
Kisely, S. R., Campbell, L. A., & Preston, N. J. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004408.pub2 · Cited by 93 · see citing works
Community Treatment Orders: International Comparisons
Dawson, J. (2005) · Otago University Research Archive (University of Otago) · Cited by 87 · see citing works
Self-citationHow Mental Health Clinicians View Community Treatment Orders: A National New Zealand Survey
Romans, S. E., Dawson, J., Mullen, R., & Gibbs, A. (2004) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2004.01470.x · Cited by 74 · see citing works
Self-citationThinking Carefully About Outpatient Commitment
Appelbaum, P. S. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.3.347 · Cited by 74 · see citing works
The ethics of mandatory community treatment.
Munetz, M. R., Galon, P. A., & Frese, F. J. (2003) · PubMed · Cited by 54 · see citing works
Community treatment orders: how ethical without experimental evidence?
Burns, T. R., & Dawson, J. (2009) · Psychological Medicine · doi:10.1017/s0033291709005352 · Cited by 41 · see citing works
Self-citationThornicroft, G. (1993) · BMJ · doi:10.1136/bmj.307.6913.1213-b · Cited by 38 · see citing works
The ethical challenges of a randomized controlled trial of involuntary outpatient commitment
Swartz, M. S., Burns, B. J., George, L. K., Swanson, J. W., Hiday, V. A., Borum, R., & Wagner, H. R. (1997) · The Journal of Mental Health Administration · doi:10.1007/bf02790478 · Cited by 35 · see citing works
Burns, T. (2010) · The Psychiatrist · doi:10.1192/pb.bp.110.030254 · Cited by 26 · see citing works
Self-citationLAWFULNESS OF A RANDOMISED TRIAL OF THE NEW COMMUNITY TREATMENT ORDER REGIME FOR ENGLAND AND WALES
Dawson, J., Burns, T. R., & Rugkåsa, J. (2011) · Medical Law Review · doi:10.1093/medlaw/fwq030 · Cited by 16 · see citing works
Self-citationRandomised Controlled Trials of Mental Health Legislation
Dawson, J. (2002) · Medical Law Review · doi:10.1093/medlaw/10.3.308 · Cited by 15 · see citing works
Self-citationJethwa, K. D., & Galappathie, N. (2008) · BMJ · doi:10.1136/bmj.a613 · Cited by 14 · see citing works
Gledhill, K. (2014) · International Journal of Mental Health and Capacity Law · doi:10.19164/ijmhcl.v1i16.211 · Cited by 7 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Lukoff D, Nuechterlein K, Ventura J. Manual for expanded brief psychiatric rating scale (BPRS). Schizophr Bull 1986; 12: 594-602.
Cited by
Sorted by citations
Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems
Slade, M., Amering, M., Farkas, M., Hamilton, B., O'Hagan, M., Panther, G., Perkins, R., Shepherd, G., Tse, S., & Whitley, R. (2014) · World Psychiatry · doi:10.1002/wps.20084 · Cited by 949 · see citing works
The WPA-Lancet psychiatry commission on the future of psychiatry
Bhugra, D., Tasman, A., Pathare, S., Priebe, S., Smith, S., Torous, J., Arbuckle, M. R., Langford, A., Alarcón, R. D., Chiu, H. F. K., et al. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30333-4 · Cited by 392 · see citing works
Self-citationBarbui, C., Purgato, M., Abdulmalik, J., Caldas-de-Almeida, J. M., Eaton, J., Gureje, O., Hanlon, C., Nosè, M., Ostuzzi, G., Saraceno, B., et al. (2021) · The British Journal of Psychiatry · doi:10.1192/bjp.2020.144 · Cited by 148 · see citing works
Compulsion and “coercion” in mental health care
Szmukler, G. (2015) · World Psychiatry · doi:10.1002/wps.20264 · Cited by 147 · see citing works
Compulsory community and involuntary outpatient treatment for people with severe mental disorders.
Kisely, S. R., Campbell, L. A., & O'Reilly, R. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004408.pub5 · Cited by 123 · see citing works
A systematic review of the effect of community treatment orders on service use
Maughan, D., Molodynski, A., Rugkåsa, J., & Burns, T. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-013-0781-0 · Cited by 106 · see citing works
Effectiveness of community treatment orders: The international evidence
Rugkåsa, J. (2016) · The Canadian Journal of Psychiatry · doi:10.1177/0706743715620415 · Cited by 98 · see citing works
Self-citationBarnett, P., Matthews, H., Lloyd-Evans, B., Mackay, E., Pilling, S., & Johnson, S. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30382-1 · Cited by 89 · see citing works
Patient, psychiatrist and family carer experiences of community treatment orders: qualitative study
Canvin, K., Rugkåsa, J., Sinclair, J., & Burns, T. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0906-0 · Cited by 56 · see citing works
Self-citationA systematic review of the views and experiences of subjects of community treatment orders
Corring, D., O'Reilly, R., & Sommerdyk, C. (2017) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2017.03.002 · Cited by 51 · see citing works
Kisely, S., & Hall, K. (2014) · The Canadian Journal of Psychiatry · doi:10.1177/070674371405901010 · Cited by 49 · see citing works
Stensrud, B., Høyer, G., Granerud, A., & Landheim, A. S. (2015) · Issues in Mental Health Nursing · doi:10.3109/01612840.2014.955933 · Cited by 47 · see citing works
Riley, H., Høyer, G., & Lorem, G. F. (2014) · Health & Social Care in the Community · doi:10.1111/hsc.12107 · Cited by 46 · see citing works
Light, E. M., Robertson, M. D., Boyce, P., Carney, T., Rosen, A., Cleary, M., Hunt, G. E., O’Connor, N., Ryan, C., & Kerridge, I. H. (2014) · Australasian Psychiatry · doi:10.1177/1039856214540759 · Cited by 34 · see citing works
The subjective experience of community treatment orders: Patients’ views and clinical correlations
Newton-Howes, G., & Banks, D. (2014) · International Journal of Social Psychiatry · doi:10.1177/0020764013498870 · Cited by 21 · see citing works
Coercion in Outpatients under Community Treatment Orders: A Matched Comparison Study
Nakhost, A., Sirotich, F., Pridham, K. M. F., Stergiopoulos, V., & Simpson, A. I. F. (2018) · The Canadian Journal of Psychiatry · doi:10.1177/0706743718766053 · Cited by 19 · see citing works
Community treatment orders and reduced time in hospital: a nationwide study, 2007-2012
Taylor, M., Macpherson, M., Macleod, C., & Lyons, D. (2016) · BJPsych Bulletin · doi:10.1192/pb.bp.115.051045 · Cited by 19 · see citing works
Perceived coercion in persons with mental disorder in India: A cross-sectional study
Raveesh, B., Pathare, S., Lepping, P., Noorthoorn, E., Gowda, G., & Bunders-Aelen, J. G. F. (2016) · Indian Journal of Psychiatry · doi:10.4103/0019-5545.196846 · Cited by 16 · see citing works
Morandi, S., Golay, P., Lambert, M., Schimmelmann, B. G., McGorry, P. D., Cotton, S. M., & Conus, P. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2016.12.022 · Cited by 16 · see citing works
Riley, H., Sharashova, E., Rugkåsa, J., Nyttingnes, O., Christensen, T. B., Austegard, A.-T. A., Løvsletten, M., Lau, B., & Høyer, G. (2019) · BJPsych Open · doi:10.1192/bjo.2019.60 · Cited by 11 · see citing works
Self-citationDangerous Discourses: Masculinity, Coercion, and Psychiatry.
Van Veen, C., Ibrahim, M., & Morrow, M. (2018) · Containing Madness · doi:10.1007/978-3-319-89749-3_11 · Cited by 10 · see citing works
Lam, E. H. Y., Lai, E. S. K., Lai, E. C. L., Lau, E., Siu, B. W. M., Tang, D. Y. Y., Mok, C. C. M., & Lam, M. (2023) · East Asian Archives of Psychiatry · doi:10.12809/eaap2246 · Cited by 7 · see citing works
- Authors
- Burns, T., Rugkåsa, J., Molodynski, A., Dawson, J., Yeeles, K., Vazquez-Montes, M., Voysey, M., Sinclair, J., & Priebe, S.
- Affiliations
- University of Oxford (GB)
- Akershus University Hospital (NO)
- Oxford Health NHS Foundation Trust (GB)
- University of Otago (NZ)
- University of Southampton (GB)
- Queen Mary University of London (GB)
- Corresponding author
- Burns, Tom
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2013-05
- Volume
- 381
- Issue
- 9878
- Pages
- 1627-1633
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2142344992
- Cited by
- 347
- References
- 20
- Citations by year
- 2026: 8 · 2025: 17 · 2024: 5 · 2023: 10 · 2022: 8 · 2021: 14 · 2020: 19 · 2019: 28 · 2018: 47 · 2017: 39 · 2016: 41 · 2015: 36 · 2014: 45 · 2013: 29
- FWCI
- 56.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- 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, psychosis, hospital readmission, involuntary psychiatric admission, deinstitutionalization, schizophrenia, involuntary treatment, mental health law, community mental health
- MeSH terms
- Adolescent, Adult, Aged, Community Mental Health Services, Female, United Kingdom, Hospitalization, Humans, Male, Middle Aged, Patient Readmission, Psychotic Disorders, State Medicine, Linear Models, Treatment Outcome, Statistics, Nonparametric
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
