Community treatment orders and social outcomes for patients with psychosis: a 48-month follow-up study


Community treatment orders (CTOs) are widely used internationally despite a lack of evidence supporting their effectiveness. Most effectiveness studies are relatively short (12-months or less) and focus on clinical symptoms and service data, while a little attention is given to patients’ social outcomes and broader welfare. We tested the association between the duration of CTO intervention and patients’ long-term social outcomes.

A sub-sample (n = 114) of community-based patients from the Oxford Community Treatment Order Evaluation Trial (OCTET) were interviewed 48 months after randomisation. Multivariate regression models were used to examine the association between the duration of the CTO intervention and social outcomes as measured by the social network schedule, Objective Social Outcomes Index, Euro-Qol EQ-5D-3L (EQ-5D), and Oxford Capabilities Questionnaire for Mental Health.

No significant association was found between the duration of CTO intervention and social network size (IRR = 0.996, p = .63), objective social outcomes (B = −0.003, p = .77), health-related quality of life (B = 0.001, p = .77), and capabilities (B = 0.046, p = .41). There were no between-group differences in social outcomes when outcomes were stratified by original arm of randomisation. Patients had a mean of 10.2 (SD = 5.9) contacts in their social networks, 42% of whom were relatives.

CTO duration was not associated with improvements in patients’ social outcomes even over the long term. This study adds to growing concerns about CTO effectiveness and the justification for their continued use.
Social networks Objective social outcomes Health-related quality of life Capabilities, OxCAP-MH Longitudinal

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Well, that’s interesting and all, but why check that and not check rates of suicide, incarceration, homelessness, hospital admission, violence (being a victim or perpetrator) accidental death etc. ?

I think they have studied the effect of CTOs on hospital readmission, and found it beneficial. Of course, when the CTO ends, people get readmitted because they are not cured. So yeah. But that’s like saying, we gave cancer patients pain meds, but when we took it away, they had pain again, so pain meds aren’t effective.

I don’t know how you all feel about it, but I feel like the number of people I know has very little to do with my functionality.

Research on CTOs -"community+treatment+orders"

Certainly a controversial thing , with mixed opinions on their usefulness.

I would say that if you are very ill ,and withdrawn , you are likely to have fewer social contacts than if you are more well.

However level of illness may not always correspond with level of social contact. For me I have no real life friends and thus no social contacts outside of family. Social interaction difficulties are chronic and pronounced but overall symptoms wise I would not say I was a severe case in terms of functionality. A moderate case maybe.
However certainly I would be more socially functional without the social interaction difficulties.

I know the Oregon equivalent of of a CTO made me even more paranoid and made me resentful of everyone involved in it. In my opinion, It should be voluntary if you’re not violent and if you haven’t committed a crime.

I’m not sure any of the current meds, voluntary or involuntary, have been proven to increase social interaction. It’s an area of unmet need.

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I get that, but, it’s hard to say who is going to become violent, suicidal, or break the law, and once that happens, you’re kind of screwed. Not only do you have to deal with the disease, but all the repercussions of whatever happened.

Not that they don’t do it badly.

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