Supervised community treatment in Birmingham and Solihull: First 6 months

Abstract

Aims and method: To describe the first 6 months of the newly introduced community treatment orders (CTOs) in Birmingham and Solihull mental health services; to establish a clearer picture of patterns of use and some early outcomes. Computerised note systems were used to collect a range of sociodemographic and clinical data using a specially designed data collection tool. Results: We observed higher than expected numbers of CTOs compared with previous use of Section 25 supervised discharge. Our results were consistent with international studies in showing that CTOs are typically used in males aged around 40 with a primary diagnosis of psychotic illness. Compared with the census population, Black and minority ethnic groups were overrepresented in our sample. There were high recorded rates of comorbid alcohol or substance misuse and violence. The majority of patients on CTOs were being followed up by community mental health teams or assertive outreach teams. Clinical implications: It is difficult to draw firm conclusions at this early stage of implementation. However, there are likely to be resource implications in view of the high numbers of CTOs applied compared with Section 25 discharge. Service providers, clinicians and commissioners need to ensure CTOs are backed up by high-quality care. Further research is required into the impact of CTOs on a range of outcomes and to understand differential rates of CTO across different ethnic groups. Declaration of interest: None.