AGHPS November 9th 2012

Environmental Scan Ontario Charter Challenge Oxford CTO Evaluation Trial

Do CTOs Work? What type of CTO? For what type of patient? Work in what way? Work to deliver what type of treatment? Work when used for how long? O’Reilly R. Research on community treatment orders. In Vingilis E, State S. Eds Applied Research and evaluation in community mental health services. Pages 68-79. McGill-Queens University Press 2011

Are there best practices with CTOs? Geller JL. Clinical Guidelines for the use of involuntary outpatient treatment. Hospital and Community Psychiatry 41:749-55, 1990. O’Reilly R, Dawson J, Burns B. Best Practices in the Use of Involuntary Outpatient Treatment. Psychiatric Services 2012;63:421-3.

Purpose of CTOs Least restrictive alternative To stop the revolving door Reduce community violence Increase the potential for recovery

For what type of patients? Diagnostically - schizophrenia spectrum illnesses and some manic depressive patients Patients who are refusing treatment or have a history of non-adherence to treatment Patients who are incapable of consenting to their own psychiatric treatment Patients who without treatment will predictably deteriorate and pose a risk to themselves or to others. Patients who will accept and follow the CTO

Work in what way? Outcome measure Reduction of bed utilization Increase follow-up with mental health service Reduce violence and arrests Reduce victimization Reduce mortality Improve quality of life

Work with what type of treatment? Follow-up with psychiatrist and case manager Take psychotropic medication Long-acting injections of antipsychotic medication Live in a specific type of residence Will reside in a group home or residential setting, which by program design supports the development of life skills and promotes treatment adherence

How long does a CTO take to work? North Carolina RCT - a minimum of 6 months Qualitative research suggests that “real” change takes about a year For how long should a CTO continue in place?