Study finds that Community Treatment Orders do not reduce hospital readmission rates or stays.
People who are in hospital on certain sections of the Mental Health Act can be discharged from hospital onto a Community Treatment Order (CTO). This means being subject to recall to hospital and abiding by conditions in the community. They are perceived as coercive, discriminatory and intrusive to those subject to them. Black or Black British people are over eight times more likely than White people to be made the subject of CTOs.
This is the first, large, observational study with a control group about CTOs in England and Wales which was funded by the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre.
This study found that CTOs are associated with an increased risk of readmission as well as increased time spent in psychiatric hospitals, contrary to results from previous uncontrolled studies.
Researchers compared 830 patients who were discharged on a CTO with 3,659 patients discharged to voluntary community mental healthcare. Results showed that in the two years following discharge from psychiatric hospital, patients on CTOs spent, on average, 17.3 additional days in hospital and had a 60% greater rate of readmission compared to patients receiving voluntary care. The study also found that the average CTO lasted three years, more than four times longer than initial government projections of nine months.
Mind welcomes the new research which strengthens findings of previous studies like the OCTET report. Given people's experience of CTOs, the strong sense of racial discrimination and the research evidence that they are ineffective, we have been calling for CTOs to be repealed.
Enabling people to be discharged from hospital and supporting their ongoing recovery would be better achieved by mandating the provision of community support through statutory, co-produced aftercare and crisis plans, with sufficient resources to be effective, and using other powers where additional oversight or community testing is necessary. Section 17 can be used for short term testing in the community, subject to regular reviews, while the Mental Capacity Act exists to authorise longer term arrangements for those who lack capacity to make decisions about their care and treatment.
We were disappointed with the recommendations about CTOs in the Independent Review of the Mental Health Act and we do not think that they will achieve its objective of halving the numbers of CTOs and would like a commitment for a further review.
The study can be found here.
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