Effectiveness of Community Treatment Orders: The International Evidence

In this systematic review, “Effectiveness of Community Treatment Orders: The International Evidence” (Rugkåsa, 2016), the researcher examines the effectiveness of community treatment orders (CTO), drawing on the evidence from the literature published before 2013. The primary objective of this study was to critically examine the practicality of CTO that, over the last few decades, has become a preferred clinical and policy solution for tackling non-adherence.

CTO makes adherence a legal requirement, which prevents relapses and readmissions. Rugkåsa (2016) reports that it was possible to locate more than 200 empirical studies addressing CTO on databases such as PsycINFO, Medline, and Embase. However, only 80 studies out of 200 employed the desired quantitative methodology that the author prioritized in his review. Keyword and hand search helped Rugkåsa (2016) narrow down the pool of articles to 19 most relevant papers. Because the author was focusing on patient outcomes, particular attention was given to RCTs (randomized control trials), while descriptive studies only received a brief mention.

The descriptive studies address the knowledge and attitudes of clinicians, families of patients, and patients themselves with regards to CTO. Clinicians appear to be the most optimistic about the policy solution: they show a preference for having CTO as an option and overwhelmingly believe that it yields the desired effects. Family members, on the other hand, find CTO helpful but have doubts as to whether the regulations truly have a positive effect on patients’ lives.

They admit that they would like to see other community services being offered on par with CTO. Patients report mixed views: akin to their family members, they do believe in some use of the approach but see some of the aspects of its implementation as restrictive and problematic. All three analyzed groups share a common goal: they seek to avoid hospital admission and readmission.

The outcome studies in CTO primarily measure readmission rates, length of stay, and use of community services. Other variables that proved to be of interest to the researchers are the number of admissions, medication use, adherence, arrest, mortality, and perceived coercion. Rugkåsa (2016) states that the findings of the outcome studies were difficult to generalize because they lacked consistency in measuring approaches and methodology. The researcher singled out three studies with similar samples conducted in New York, North Carolina, and OCTET (Oxford Community Treatment Order Evaluation Trial). Comparing the studies and analyzing their findings have shown that CTO did not have any significant impact on any of the measured variables except for victimization in the North Carolina Study.


Rugkåsa, J. (2016). Effectiveness of community treatment orders: The international evidence. The Canadian Journal of Psychiatry, 61(1), 15-24.