Community treatment orders

In 2008, Community Treatment Orders (CTOs) became available under the amended Mental Health Act 2007 as a means of supervizing people with severe mental disorders in the community following involuntary hospital stays. The orders were intended to prevent relapse following discharge from hospital by requiring the patient to comply with treatment. Patients can be recalled to hospital should they not comply. The introduction of CTOs has been subject to fierce debate, which is still ongoing. This is, in part, due to a lack of convincing evidence for efficacy. The guidance from the Department of Health and from some NHS Trusts seems to favour CTOs over other means of supporting patients in the community. Early figures indicate that CTOs have already been used extensively, despite a lack of evidence to guide clinical practice. A few teething problems have been identified such as the availability of Second Opinion Appointed Doctors and the ways in which services are organized, which impacts on CTO implementation and continuity of care. Experimental research to identify for whom and in what ways CTOs may have benefits is sorely needed to aid clinical decision making.