Major review sheds doubt on Community Treatment Orders

A major review by the Institute of Psychiatry has concluded that there is little evidence to suggest that Community Treatment Orders – a key plank of the UK Government’s plans to change mental health laws – are beneficial to patients.

The Mental Health Bill would allow people with untreatable personality disorders to be detained, even if they have committed no crime.

But the Institute of Psychiatry, which is based at King’s College, London, found “very little evidence of positive effects of CTOs in the areas where they might have been anticipated.”

“Proponents of CTOs argue that they will lead to a decrease in hospital admissions and that they are less coercive than the hospitalization or imprisonment – there is, so far, no evidence to support this,” the report states.

Community treatment orders are a form of compulsory community treatment
law that began to appear in North American and Australasian jurisdictions during the

They provide a legal framework within which patients with a serious mental
disorder may be required to accept psychiatric treatment while living outside hospital.

The Institute of Psychiatry review, the most comprehensive of its kind to date in Britain, examined 72 studies into the use of CTOs in six countries but found it impossible to state whether they provided any benefit to patients.

The report found no evidence that CTOs:
• reduced subsequent inpatient admissions
• enabled closer monitoring and more clinical contact with patients during symptom relapses
• increased compliance with treatment
• result in improved outcomes for patients.

The report’s authors said:”On the basis of all available studies, there is no evidence that CTOs keep patients out of hospital.”

“There was no significant difference between the CTO and control
groups in terms of patient level outcomes including social functioning, offences resulting in arrest, homelessness, general mental state, psychopathology, quality of life, carer satisfaction, or perceived coercion.”

Community Treatment Orders are a major element of Government plans to change Britain’s mental health legislation under the Mental Health Bill currently making its way through Parliament.

But peers in the House of Lords last month inflicted a defeat on the UK Government by voting that CTOs, which would previously have applied to anyone who had been sectioned, could only apply to so-called “revolving door” patients.

* To read the full Institute of Psychiatry report, go to