title: Canadian Studies on the Effectiveness of Community Treatment Orders.
abstract: OBJECTIVE
  Community treatment orders (CTOs) for people with severe mental illnesses are used across most of Canada. It is unclear if they can reduce health service use, or improve clinical and social outcomes. This review summarizes the evidence from studies conducted in Canada.
  
  
  METHODS
  A systematic literature search of PubMed and MEDLINE to March 2015 was conducted. Inclusion criteria were quantitative and qualitative studies undertaken in Canada that presented data on the effect of CTOs on outcomes.
  
  
  RESULTS
  Nine papers from 8 studies were included in the review. Four studies compared health service use before and after compulsory treatment as well as engagement with psychosocial supports. Three were qualitative evaluations of patients, family, or staff and the last was a postal survey of psychiatrists. Hospital readmission rates and days spent in hospital were all reduced following CTO placement, while outpatient attendance and participation in psychiatric services and housing all improved. Family members and clinicians were generally positive about the effect of CTOs but patients were ambivalent. However, the strength of the evidence was limited as many of the studies were small, only one included control subjects, and there was no adjustment for potential confounders using either matching or multivariate analyses. Only 2 qualitative studies included the views of patients and their families.
  
  
  CONCLUSIONS
  The evidence base for the use of CTOs in Canada is limited and this lack of Canadian research is in marked contrast to other countries where there have been large studies that have used randomized or matched control subjects. Their use should be kept under review.
authors: Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia University of Queensland, School of Medicine, Herston, Australia s.kisely@uq.edu.au.
authors: Steve
authors: S
authors: Kisely
mesh_terms: D002170:Canada; D003134:Commitment of Persons with Psychiatric Disorders; D003156:Community Mental Health Services; D006801:Humans
keywords: community treatment orders; compulsory community treatment; controlled-before-and after study; mirror-image studies; readmission; uncontrolled-before-and after study