AGHPS November 9th 2012
Environmental Scan • Ontario Charter Challenge • Oxford CTO Evaluation Trial
Do CTOs Work? • What type of CTO? • For what type of patient? • Work in what way? • Work to deliver what type of treatment? • Work when used for how long? • O’Reilly R. Research on community treatment orders. In Vingilis E, State S. Eds Applied Research and evaluation in community mental health services. Pages 68-79. McGill-Queens University Press 2011
Are there best practices with CTOs? • Geller JL. Clinical Guidelines for the use of involuntary outpatient treatment. Hospital and Community Psychiatry 41:749-55, 1990. • O’Reilly R, Dawson J, Burns B. Best Practices in the Use of Involuntary Outpatient Treatment. Psychiatric Services 2012;63:421-3.
Purpose of CTOs • Least restrictive alternative • To stop the revolving door • Reduce community violence • Increase the potential for recovery
For what type of patients? • Diagnostically - schizophrenia spectrum illnesses and some manic depressive patients • Patients who are refusing treatment or have a history of non-adherence to treatment • Patients who are incapable of consenting to their own psychiatric treatment • Patients who without treatment will predictably deteriorate and pose a risk to themselves or to others. • Patients who will accept and follow the CTO
Work in what way? • Outcome measure • Reduction of bed utilization • Increase follow-up with mental health service • Reduce violence and arrests • Reduce victimization • Reduce mortality • Improve quality of life
Work with what type of treatment? • Follow-up with psychiatrist and case manager • Take psychotropic medication • Long-acting injections of antipsychotic medication • Live in a specific type of residence • Will reside in a group home or residential setting, which by program design supports the development of life skills and promotes treatment adherence
How long does a CTO take to work? • North Carolina RCT - a minimum of 6 months • Qualitative research suggests that “real” change takes about a year • For how long should a CTO continue in place?