Community Treatment Orders:Before and After Study Version 4 25.07.2019
Research type
Research Study
Full title
Community Treatment Orders under the Mental Health Act 1983: before and after study of readmission, stability and quality of life
IRAS ID
261962
Contact name
Robert Keys
Contact email
Sponsor organisation
NELFT
Clinicaltrials.gov Identifier
None, None
Duration of Study in the UK
0 years, 3 months, 12 days
Research summary
Before and After study of group of patients on a Community Treatment Order of the Mental Health Act 1983
Study to look at a random selection of 50 NELFT patients currently on a CTO and with a duration of episode of 2 years( average duration of NELFT CTOs is currently 2.5 years).
NELFT is a significant user of CTOs with more patients on a CTO than detained in hospital at any one time and a higher usage than any other London Trust.
To study key indicators in the two years before referral to a CTO, such as:
- Readmission to hospital
- Above in terms of numbers of episodes and numbers of days spent in hospital
- Serious Incident
- Criminal Incident
- Presentation on S.136
- Stability of residence
- HOHOS score(if available)
- Other
To study the incidence of the same indicators in the 2 years after being placed on a CTO.
To look at the use of recall and percentage of cases where it was used to administer medication and allow discharge within 72 hours
To look at the percentage of cases where recall resulted in revocation of the CTO and reversion to a S.3
To conduct a personalised, structured interview with the patient, where the patient consents, to obtain their view on the effect of the CTO and of what is their current overall well-being.
To construct a profile of the patient group, including: age; gender; sexual orientation; ethnicity.
To establish whether CTOs have a proven clinical benefit.
The back ground to the Project is high national use of CTOs over a 10 year period, far higher than initial Government estimates. Early indications from the MHA Review group are that, though they propose some reforms to CTOs as they currently stand, they do not propose their abolition. It is possible therefore that there will be a continued high investment of clinical time and resources in CTOs over many more years . At the same time there is a lack of clear evidence about their clinical effectiveness. The one major double blind study, the Octet Study by Professor Burns, found no significant effect on readmission to hospital rates. However, this study stands alone and looked solely at readmission within a one year period at an early stage in the use of CTOs. Proposals to repeat this study, or do a similar one, are believed to have met with ethical objections( as it would mean deliberately not placing some patients on a CTO who, if CTOs do have a clinical benefit, might have gained from it). This leaves open the idea of a Before and After study which is not open to a similar objection. Overall this is a suitable time to conduct research into a power that has become widely used and deeply embedded in psychiatry but is still of questionable ethical and clinical value.REC name
London - Brighton & Sussex Research Ethics Committee
REC reference
19/LO/1412
Date of REC Opinion
20 Sep 2019
REC opinion
Unfavourable Opinion