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Evaluating the effects of Community Treatment Orders (CTO) in England

Research overview

Community Treatment Orders (CTOs) were introduced in England 2008. CTOs allow patients detained in hospital for treatment under the Mental Health Act (2007) (MHA) to be discharged under specific conditions. The extent of their use was unexpected: around 20,000 patients have been placed on CTOs to date. Large variation in their use has been noted, and monitoring by the Care Quality Commission (CQC) suggests that patients of black and minority (BME) ethnicity are over-represented among those on CTOs. Evidence of effectiveness is sparse, and the only (three) clinical trials worldwide all failed to show any effects on clinical outcomes. Reviews of observational studies broadly confirm this, although results are more mixed. There have been no population-based studies of the use or effects of CTOs in England.

The study will:

  1. explore spatial and secular variation in the use of CTOs in England over a four-year period (from 2011/12, including variation between people (and especially different ethnic groups), places and services and over time;
  2. describe and model associations between CTO use and outcomes, namely re-admission, time spent in hospital, time spent in intensive psychiatric care or forensic units, episodes of seclusion and restraint, community mental health service contacts, criminal justice system contacts, Accident & Emergency Department attendances and deaths, after adjusting for patient characteristics;
  3. test the hypotheses that outcomes associated with CTOs vary between people and places; and
  4. model the health care costs associated with CTOs (including administrative and regulatory costs) and the impacts of increasing or decreasing their use using a range of projections.

Benefit

This study will provide an independent assessment and evaluation of CTOs, their use, outcomes and cost effectiveness, and include both geographical and population variations. 

The results from this study:

  • can help inform mental health policy and support commissioning decisions on productive monitoring procedures for CTOs
  • will help direct mental health care related funds to where they are most needed
  • can then be translated into patient-approved interventions
  • shared at the earliest opportunity with the Care Quality Commission, the Department of Health, the Chief Medical Officer, the Royal College of Psychiatrists, the NHS Confederation, and NICE
  • might inform future interventions to reduce compulsory admission and variation in CTO use

 The research team will work on facilitating the adoption of these patient beneficial interventions within the NHS.


Government departments

Data from the Office for National Statistics, NHS Digital and the Department for Communities and Local Government


Date Approved

April 2016


Research team

Prof Scott Weich, University of Sheffield 

Prof Graham Moon, ADRC-E and University of Southampton

Prof Liz Twigg, University of Portsmouth

Dr Craig Duncan, University of Portsmouth

Dr Orla McBride, Ulster University


Page last updated: 24/10/2017