Community Treatment Orders: (CTOs) Why can't we accept the evidence?

Speaker: Professor Tom Burns, University of Oxford

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Abstract: Community Treatment Orders (CTOs): Why can't we accept the evidence?

The OCTET trial, published in 2013 was the third RCT of compulsory community psychiatric treatment (CTOs in the UK, Assisted Outpatient Treatment (AOT) in the US). Like its two predecessors OCTET found no advantage to CTOs in the common primary outcome of rate of readmission over a 12 month follow up, nor, indeed in any other outcomes. Systematic reviews and meta-analyses confirm that there are no benefits in the whole range of outcomes. However CTOs are being rolled out internationally and over 4000 are imposed in the UK per year.

Why the discrepancy between repeated clinical observations of a positive effect and a striking failure to demonstrate this scientifically? Why is there no positive effect? More to the point why do we persist with a disruptive and stigmatising intervention in the teeth of the evidence?