Recall of patients on community treatment orders over three years in the OCTET CTO cohort.
BACKGROUND
Randomised studies consistently show that Community Treatment Orders (CTOs) do not have the intended effect of preventing relapse and readmissions of patients with severe and enduring mental illness. Critics suggest this in part can be explained by RCTs studying newly introduced CTO regimes and that patients therefore were not brought back to hospital for short-term observations ('recall') as frequently as intended. Our purpose was (i) to test the hypothesis that CTO practice as regards recall of patients to hospital in England and Wales was as rigorous under the OCTET trial period as in current routine use and (ii) to investigate the reasons for and outcomes of recalls and whether this changed over time.


METHODS
Thirty six-month observational prospective study of 198 patients in the OCTET Follow-up Study.


RESULTS
Forty percent of patients were recalled, 19 % more than once. This is in line with current national use. Deterioration in clinical condition was the most common reason for recalls (49 %), and 68 % of recalls resulted in revocation of the order (i.e., retention in hospital under compulsion). This pattern remained stable over time.


CONCLUSIONS
The use of recall cannot explain why RCTs have not confirmed any benefits from CTOs, and their continued use should be reconsidered.


BACKGROUND
The OCTET Trial was retrospectively registered on 12 November 2009 ( ISRCTN73110773 ).
Health Services Research Unit, Akershus University Hospital, 1478, Lørenskog, Norway. jorun.rugkasa@ahus.no.|Department of Psychiatry, University of Oxford, Oxford, UK. jorun.rugkasa@ahus.no.
Jorun
http://orcid.org/0000-0001-5842-2845
J
Rugkåsa
Department of Psychiatry, University of Oxford, Oxford, UK.
Ksenija
K
Yeeles
Department of Primary Care, University of Oxford, Oxford, UK.
Constantinos
C
Koshiaris
Department of Psychiatry, University of Oxford, Oxford, UK.
Tom
T
Burns
D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000379:methods / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D037141:Mandatory Programs / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D014852:Wales; D055815:Young Adult
Community Treatment Order; Community compulsion; OCTET trial; Outpatient Commitment; Recall; Revocation