Abstract

Background: Community treatment orders (CTOs) are used to manage community-based care for individuals with severe mental health conditions who have been discharged from inpatient care. Evidence examining whether CTOs are successful at reducing rehospitalisation has been mixed. Methods: Using deidentified electronic health records from 2009-21, we compared patients who had ever been placed on a CTO (n=836) and two other groups of patients who had never been placed on CTO: patients admitted under Section 3 of the Mental Health Act (n=1,182) and outpatients with severe mental health issues (n=7,651). We examined the association between CTOs and rehospitalisation using within-individual stratified multivariable Cox regression. Results: Patients on CTO were more likely to be male, single, of Black or Mixed ethnicity, and have a severe mental illness diagnosis than patients in the comparison groups. Time spent on CTO was associated with a lower risk of hospitalisation compared to time spent off CTO for the same individual (HR 0.60; 95% CI 0.56-0.64). This decreased risk of hospitalisation remained when we restricted analysis to individuals with a single CTO episode (HR 0.05; 95% CI 0.02-0.11) and when we restricted follow-up time to a patient's first CTO episode (HR 0.20; 95% CI 0.17-0.25). However, there was no difference in re-hospitalisations when we observed patients starting from the first CTO (HR 1.07; 95% CI 1.00-1.16). Conclusions: We found that patients on CTO were at lower risk of hospitalisation, though this pattern was not observed when we excluded time prior to the first CTO. Further research should consider whether CTOs provide genuine clinical benefit. Keywords: community treatment orders, compulsory community treatment, hospitalisation rates, within individual analysis, electronic health records, clinical informatics