title: Community Treatment Orders-A pause for thought.
abstract: Community Treatment Orders (CTO) have been available for several decades in some countries and are being progressively introduced worldwide, with significant uptake in Asian countries as they move more mental health care into the community. However the evidence for the effectiveness of CTOs is limited. The evidence from local audits and evaluations is conflicted with some studies showing clear benefit and others not. The same is the case for uncontrolled before and after studies. The higher levels of evidence such as randomised controlled trials, systematic reviews, and Cochrane reviews have consistently failed to demonstrate benefits from CTO use on key measures such as symptom levels, functioning, and healthcare use. Despite this they are increasingly available internationally and often greeted enthusiastically by clinicians and families who want to ensure care and follow up for the mentally ill. This article briefly discusses the evidence before describing potential alternatives to the use of compulsion that do have an evidence base, such as multidisciplinary community working, housing initiatives, and employment support.
authors.affiliation: Oxford Health NHS Foundation Trust, United Kingdom. Electronic address: m.kaur.86@hotmail.com.
authors.forename: Maninder
authors.initials: M
authors.lastname: Kaur Nagra
authors.affiliation: Institute of Psychiatry, King's College London, United Kingdom.
authors.forename: Toby
authors.initials: T
authors.lastname: Pillinger
authors.affiliation: Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal.
authors.forename: Henrique
authors.initials: H
authors.lastname: Prata-Ribeiro
authors.affiliation: Geneva University Hospitals and Geneva University, Geneva, Switzerland.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Khazaal
authors.affiliation: Oxford Health NHS Foundation Trust, United Kingdom; Oxford University, United Kingdom; World Association of Social Psychiatry Working Group on Coercion, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Molodynski
mesh_terms: D003156:Community Mental Health Services / Q000592:standards*; D055317:Evidence-Based Practice / Q000592:standards*; D006801:Humans
keywords: Community mental health care; Community treatment orders; Evidence based health care