Canadian studies on the effectiveness of community treatment orders

Kisely, Steve (2016) Canadian studies on the effectiveness of community treatment orders. Canadian Journal of Psychiatry, 61 1: 7-14. doi:10.1177/0706743715620414

Author Kisely, Steve
Title Canadian studies on the effectiveness of community treatment orders
Journal name Canadian Journal of Psychiatry   Check publisher's open access policy
ISSN 1497-0015
Publication date 2016-01
Year available 2016
Sub-type Article (original research)
DOI 10.1177/0706743715620414
Open Access Status Not Open Access
Volume 61
Issue 1
Start page 7
End page 14
Total pages 8
Place of publication Thousand Oaks, CA, United States
Publisher Sage Publications
Collection year 2017
Language eng
Formatted abstract
Objectives: Community treatment orders (CTOs) for people with severe mental illnesses are used across most of Canada. It is unclear if they can reduce health service use, or improve clinical and social outcomes. This review summarizes the evidence from studies conducted in Canada.

Method: A systematic literature search of PubMed and MEDLINE to March 2015 was conducted. Inclusion criteria were quantitative and qualitative studies undertaken in Canada that presented data on the effect of CTOs on outcomes.

Results: Nine papers from 8 studies were included in the review. Four studies compared health service use before and after compulsory treatment as well as engagement with psychosocial supports. Three were qualitative evaluations of patients, family, or staff and the last was a postal survey of psychiatrists. Hospital readmission rates and days spent in hospital were all reduced following CTO placement, while outpatient attendance and participation in psychiatric services and housing all improved. Family members and clinicians were generally positive about the effect of CTOs but patients were ambivalent. However, the strength of the evidence was limited as many of the studies were small, only one included control subjects, and there was no adjustment for potential confounders using either matching or multivariate analyses. Only 2 qualitative studies included the views of patients and their families.

Conclusions: The evidence base for the use of CTOs in Canada is limited and this lack of Canadian research is in marked contrast to other countries where there have been large studies that have used randomized or matched control subjects. Their use should be kept under review.
Keyword Community treatment orders
Compulsory community treatment
Controlled-before-and after study
Mirror-image studies
Uncontrolled-before-and after study
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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