Friday, 19 April 2013

Community treatment orders 'don't reduce psychiatric readmissions'

Community treatment orders 'don't reduce psychiatric readmissions': "'Psychiatric Asbos' were an error says key advisor," The Independent reports. The news comes from new research examining the effectiveness of community treatment orders (CTOs), a legal measure that allows mental health teams to impose compulsory supervision on a patient after they have been discharged from an involuntary stay in hospital.

Patients may also be ordered to meet other requirements, such as taking medication or living in a specified place, or be faced with readmission to hospital. For this reason, CTOs are controversial as they restrict patients' personal liberty.
This well-designed piece of research on patients in England found that CTOs were no better at stopping people with psychosis from being readmitted to hospital care than another type of legal measure that allows patients short periods of leave from psychiatric hospital care.
The study also found that CTOs did not reduce the length of time patients stayed in hospital, the severity of their symptoms, or how they coped in society.

The lead researcher on this trial, who The Independent reports originally advised the government on CTOs, was quoted as saying, "We were all a bit stunned by the result, but it was very clear data and we got a crystal clear result. So I've had to change my mind. I think sadly – because I've supported them for 20-odd years – the evidence is staring us in the face that CTOs don't work."
It is not yet clear whether changes to the legislation will be made on the basis of this single – but seemingly important – piece of research.

Where did the story come from?

This study was carried out by researchers from the University of Oxford and other research centres in the UK, Norway and New Zealand. It was funded by the UK National Institute for Health Research and was published in the peer-reviewed medical journal The Lancet.
The Independent covered the research briefly and accurately, with most of the article focusing on the social and political context in which CTOs were introduced and are being used.
However, The Independent chose to refer to them as 'psychiatric Asbos' in their headline, a rather unkind and pejorative label that suggests people receiving psychiatric care have in some way broken the law or shown antisocial behaviour towards other people, which is not necessarily the case. People receiving these orders have a mental illness that needs treatment, and a key aim of the CTOs is to protect their own health and safety.

Links To The Headlines

Burns T, Rugkåsa J, Molodynski A, et al. Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial. The Lancet. Published online March 26 2013

Links To Science

'Psychiatric Asbos' were an error says key advisor. The Independent, April 14 2013

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