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Community treatment orders do not reduce hospital readmission in people with psychosis

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Question

Question: Are community treatment orders more effective than Section 17 leave in reducing hospital readmissions in people with psychosis?

Patients: In total, 336 adults (aged 18–65 years) involuntarily hospitalised for psychosis. Eligible participants were those who could give informed consent and were suitable for supervised outpatient care.

Setting: Thirty-two National Health Service Mental Health Trusts, UK; recruitment November 2008–February 2011.

Intervention: Hospital discharge on a community treatment order (CTO) or Section 17 leave. CTOs require patients to agree to clinical monitoring and patients can be recalled for up to 72 h for assessment without readmission procedures. Section 17 leave permits patients to leave hospital for hours, days or weeks subject to readmission without further legal procedures.

Outcomes: Hospital readmission over 12 months. Secondary outcomes: time to readmission, total number of readmissions, total days of hospitalisation and clinical symptoms measured with the Global Assessment of Functioning (GAF) and Brief Psychiatric Rating Scale (BPRS).

Patient follow-up: At 12 months, 99% of participants were analysed for the primary outcome and 72% for secondary outcomes.

Methods

Design: Randomised controlled trial. …

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