Transcript December 2009 Performance Report

The first year of Community
Treatment Orders
Dr M Claire Royston MB ChB MSc FRCPsych
Medical Director Care Principles
Lead SOAD, Care Quality Commission
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Dr M Claire Royston
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History of CTOs
• First appeared in N. America and Australasia during
‘80s
• CTOs exist in 52 separate jurisdictions across the world:
– 41 States in USA
– Ontario and Saskatchewan in Canada
– All states in Australia
– New Zealand
– Israel
– Scotland
– England
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History of CTOs
Definition:
A legal mechanism by which people with
mental health problems who need treatment
are compelled to submit to treatment on an
outpatient basis
Restrictive intervention
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History of CTOs
Conceptualised in response to number of different
pressures on psychiatric services:
– Deinstitutionalisation
– Homeless mentally ill
– Over-representation of mentally ill in prison
– Revolving door patients
– Dangerous mentally ill in the community
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History of CTOs
• Conceptualised as a provision for treatment in
a less restrictive environment
• Outcome measures for ‘success’
–Successful maintenance without harm to
self or others
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History of CTOs
• Over time the concept of the purpose for the CTO has
evolved into a legal intervention with ‘health benefits’
• A legal intervention designed to benefit persons with
serious mental illness who need ongoing psychiatric
care and support to prevent relapses, hospital readmissions, homelessness or incarceration but have
difficulty following through with community-based
treatments
• This alters the type of outcome measures
• Now often considered to be a less restrictive measure
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History of CTOs
• 14 major studies completed
• Consistency in the characteristics across all jurisdictions
(very different cultural and geographical settings)
• Typically; male, around 40 years of age, long history of
mental illness, previous admissions, suffering from a
schizophrenia-like or serious affective illness
• Likely to be displaying psychotic symptoms, especially
delusions at time of inception of CTO
• Criminal offences and violence not dominant features
• Often past history of high admission rates, poor
medication compliance
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CTOs in England
• Came into effect with amendments MHA 1983 on
3 November 2008
• “Designed for patients who still require treatment for
mental disorder, on the ground of their own health or
safety or protection of others, but such treatment can
be given outside of detention hospital, provided there
is a power to recall if clinicians have concerns
community arrangements are no longer sufficient”
• Estimated number ~200 in the first year
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Number of CTO SOAD visit requests
3 November 2008 – 31 March 2009, n=1722
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CTO - changes in legal status
Number of recalls to hospital
206
Number of revocations
142
Number of discharges from SCT
32
(n = 2,109)
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Number of CTO requests: region
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Study design
From completed CTO second opinions from
3 Nov 2008 to 30 April 2009:
• 233 records located
• Records showing some change from treatment
plan prioritised, but 111 records showing no
change randomly selected.
• Audited by Lead SOAD following coding.
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History & symptom clusters
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Stated diagnosis
Stated diagnosis
F20
Frequency
Schizophrenia, schizoaffective or delusional disorder
190
F30-F39 Mood disorders
27
F50-F59 Associated physical/psychological disorders
2
F60-F69 Personality disorders
2
F70-F79 Learning disability
2
F80-F89 Psychological development
3
Non-specific
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n = 233
Assessed risk
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Categories of drug authorised
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n = 233
Number of drugs authorised
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SOAD visits to SCT – BNF limits
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The CTO experience
A legal mechanism by
which people with
mental health problems
who need treatment are
compelled to submit to
treatment on an
outpatient basis
7/17/2015
A legal intervention
designed to benefit
persons with serious
mental illness who need
ongoing psychiatric care
and support to prevent
relapses, hospital readmissions, homelessness
or incarceration but have
difficulty following through
with community-based
treatments
Dr M Claire Royston
18