Different Patient Group Responses To Community Treatment Orders Suggest Alternative Approaches

Community treatment orders (CTOs) help people with severe mental illness survive through potentially harmful crises posing imminent threats to health and safety by providing needed treatment when possible as a less restrictive alternative (LRA) to involuntary hospitalization. This review considers how differing patient subgroups have responded to differing CTO implementation approaches. Though recent trends have favored restricting psychiatric discretion, patients selected by psychiatrists as eligible for brief CTO assignment and assigned randomly to either brief or fixed-longer-term CTOs were no different in adverse outcomes other than in the duration of supervised time. Though emphasis has been on dangerousness to others, a study excluding such patients found lesser amounts of victimization among CTO-assigned vs. non-CTO patients. Though the trend has been focused on shortening CTO-duration, studies of extended six-month CTO assignment found that such patients experienced reduced inpatient days. Though emphasis has been on using CTOs with patients who have repeatedly failed in voluntary community care, studies of early intervention CTO use yielded positive results. Finally, CTO diversion has received limited use but when used had positive outcomes. Average evidence rankings for all subgroup study areas were 3.58 of 5 with 1 being the best rank. These studies, while low in evidence ranking, suggest alternative approaches may improve CTO-use outcomes for different patient subgroups.