Community treatment orders (CTOs) are legal procedures that authorize compulsory community mental health care to a mentally ill patient, usually used in severe cases (Silva & Golay, 2019, p.101509)

• Are regulated in 75 countries
• Made by the Mental Health Tribunal or by a Magistrate

in Australia

• Are widely used in Victoria(Light , Kerridge & Ryan, 2012, p. 478-482)

The debate about CTOs' effectiveness has been ongoing

Are they really effective ?

Muirhead, Harvey & Ingram's Research

2009 Australia

Effectiveness of CTOs for Treatment of Schizophrenia with Oral or Depot Antipsychotic Medication: Changes in Problem Behaviours and Social Functioning.

(Muirhead, Harvey & Ingram, 2009, p.1077-1083 )

Behavioral and social outcomes were examined in the research

Include the following:

• Employment

status

• Frequency of contact with family members and overall quality of the relationship between family and patient

• Episodes of aggression and suicidal and self-harming behaviors

• Episodes of homelessness

Ingram, et al, (2009)

Outcomes Related to CTOs Ineffectiveness

When comparing the pre- and post-CTO years

• Episodes of self-harm showed NO improvement

• Suicidal behaviors showed NO improvement

• Changes in employment showed NO improvement

Ingram, et al, (2009)

Conclusion:

This research may reinforce the effective outcome of CTOs, however, there is NO sufficient evidence to confirm the effectiveness.

(Maughan, Molodynski, Rugka˚sa & Burns, 2013)

Maughan, Molodynski, Rugka˚sa & Burns' Study

2013

A systematic review of the effect of community treatment orders on service use

Databases were searched to obtain relevant studies published from January 2006 to March 2013

18 studies including one randomised controlled trial were included

Burns et al, (2013)

• Medication adherence

A range of outcomes has been investigated

Burns et al, (2013)

• Number of inpatient days

• Community service use

• Admission rates

Results

• Burns and his colleagues found that the literature on CTOs has provided CONFLICTING results.

• In each of the outcomes investigated (other than adherence rate), there has been NO consensus of evidence which considered that CTOs are associated with any particular outcome

• The results from the UK-based RCT correspond with results from the two RCTs in the US, that there is NO evidence that showing CTOs affect admission rates or number of inpatient days

Conclusion

CTOs have NO significant effects on hospitalisation and other service use outcomes

Mikellides, Stefani, & Tantele's Suggestion 2019

(Mikellides, Stefani & Tantele, 2019, p83-86)

Community treatment orders : international perspective

Compare CTOs in Australia, New Zealand, USA, Canada, Switzerland, Scotland, & England and Wales

Conclusion and Suggestion

• It is IMPOSSIBLE to compare between studies, thus they can NOT confirm the effectiveness of CTOs

• CTOs use is expanding worldwide WITHOUT enough empirical evidence to support its efficiency

• We need pluralistic approaches in addition to traditional study designs that can provide novel information regarding the delivery of CTOs

Mikellides, et al, (2019)

The Factors that influence outcomes of CTOs

• Targeting the right population

• Perspectives of patients about treatment

• Clinical decision-making

Mikellides, et al, (2019)

To Sum Up

Studies have shown more conflicting results than confirming results on the effectiveness of CTOs

In conclusion, as more and more (especially recent) studies have shown, I agree that at this stage, there is NOT enough sufficient evidence to confirm the effectiveness of CTOs for mentally ill patients.