Do intensive services obviate the need for CTOs?

Area of Science:

• Psychiatry
• Mental Health Services Research
• Health Policy

Background:

• Community treatment orders (CTOs) are legal tools to ensure treatment adherence for individuals with severe mental illness.
• Assertive community treatment (ACT) teams provide intensive, community-based support.
• Debate exists on whether ACT services render CTOs obsolete.

Purpose of the Study:

• To determine the frequency of CTO use among patients receiving ACT services.
• To identify reasons for placing ACT patients on CTOs.
• To explore stakeholder perspectives on CTO use within ACT programs.

Main Methods:

• Retrospective chart review of patients on CTOs and ACT teams in London, Ontario (2000-2013).
• Surveys administered to psychiatrists.
• Focus groups conducted with patients, relatives, and non-psychiatrist clinicians.

Main Results:

• 190 patients were on a CTO while receiving ACT services; 17% of ACT patients had an active CTO in December 2013.
• Psychiatrists cited treatment refusal and lack of follow-up as reasons for ACT's ineffectiveness, leading to CTO use.
• Patients expressed mixed views on CTOs (coercive yet beneficial); relatives and non-psychiatrist clinicians were more supportive.

Conclusions:

• Intensive community services like ACT do not automatically ensure patient engagement.
• Legislation mandating treatment adherence remains necessary for some patients, complementing clinical services.