March 14, 2007
by Angela Hussain

There is no evidence that treating psychiatric patients under compulsion in the community is of clinical benefit, according to a report commissioned by the Department of Health.

The conclusion is another blow to government’s plans to extend compulsory powers of detention over the mentally ill. A mental health bill includes plans to introduce community treatment orders (CTOs) which would legally enforce patients living in the community to take their medication, as well as adhere to other conditions.

The House of Lords last month voted for a series of bill amendments, placing restrictions on the use of CTOs for only previously hospital-detained “revolving door” patients. Peers also defeated the government over a number of other key plans contained in the bill.

The Institute of Psychiatry report examined 72 studies into the use of CTOs in six countries. It claims to be the most comprehensive review of research into CTOs.

It concluded: “There is currently no robust evidence about either the positive or negative effects of CTOs on key outcomes, including hospital readmission, length of hospital stay, improved medication compliance, or patients' quality of life."

Paul Farmer, chief executive of the mental health charity Mind which is opposed in principle to CTOs, said the government plans were "fundamentally flawed".

"Community treatment orders won't help people at all,” he said.

"They do not improve compliance with medication. They do not lower incidents of violence or arrest. They do not reduce length of stays in hospital. They do not prevent re-admissions. But they will scare vulnerable people away from seeking help when they need it."

Rowena Daw, vice chair of the 78-member Mental Health Alliance, said: "The mental health bill proposed the widest powers of compulsion in the community of anywhere in the Western world. Yet the government's own research now shows that these orders have at best mixed results.”

Nevertheless, The Department of Health said there had been positive reports about the effect of CTOs from New Zealand, Australia, US and Scotland, which introduced CTOs in 2005.

A spokesperson told the BBC: "Community treatment orders are a key part of helping to solve the problem of 'revolving door' patients.

"We know that many tragedies in mental health are preceded by non-compliance with treatment and CTOs will address this."

Professor Louis Appleby, the government's national director for mental health, also said Oxford University would carry out further research into how CTOs will work in practice.

The mental health bill is due to be introduced to the House of Commons in Easter.

Read for yourself:
Institute of Psychiatry review on community treatment orders

See also:
Feb 28: Peers defeat government over plans to extend compulsory plans of treatment over mentally ill - controversial bill now due to go before MPs after Easter
Jan 25: Clinical psychologists should refuse to detain patients, academic urges - new government law means psychologists will be required to implement “social control”, argues David Harper
Jan 12: Government set to win bid to extend compulsion powers over mentally ill, says MP
- "I do not think there will be a major Labour rebellion," says Lynne Jones of group of MPs with previous "misgivings” over mental health bill.
Mental health comment
Dec 12, 2006: CTOs do not work...and that's according to the evidence base - Community treatment orders will help protect the public from mentally people who kill, says the government. But what of the evidence for such a claim?

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