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A follow up of the OCTET Trial

OCTET II © Social Psychiatry Department, University of Oxford

Research Team: Tom Burns, Ksenija Yeeles, Jorun Rugkåsa, Alexandra Forrest,  Stephen Puntis, Tanya Smith, Amy Mitchell, Kiki Burns, Francis Vergunst ,  Constantinos Koshiaris, Maria Vazquez-Montes

Study details:

Community Treatment Orders (CTOs) were highly controversial when they were introduced for two main reasons:

It was uncertain what benefits they would have for patients and the OCTET RCT addresses this. Over 300 patients leaving hospital after an involuntary stay were randomly allocated to either CTO or section 17 leave. Our outcome measure is whether patients on a CTO remain out of hospital longer or not, and whether they stay in for shorter periods when admitted.

2.  Negative views about CTOs as a form of coercion could mean patients stay away from services and therefore do not get the treatment they need. Disengagement from services has been raised as a concern by service user organisations as a potential harmful effect of CTOs.

An RCT can only fully answer one question at the time and OCTET Phase I was unable to include this second question during its 12-month period. We now have the opportunity to address the issue of disengagement using a unique randomised sample of 333 patients. Adding another time-point of data collection at 24 months after patients have completed the trial will tell us how a period on CTO affects engagement with services over the long term. We will measure two things: (i) loss of follow-up all together and (ii) periods of two months without service contact.  We will then compare these measures between the two groups to detect any differences.

The purpose of coercive community treatment is to assist patients in regaining insight so that they seek treatment voluntarily. CTOs thus aim to produce beneficial clinical outcomes in the longer term  (after compulsion has ceased). We will assess clinical outcomes (readmission to hospital) again at this additional time-point, which will give us new information about the long-term effect of CTOs.

No other international study has ever done this. This knowledge should improve clinical decision making and thus outcomes for patients.  While the original work will answer the question of whether CTOs give better clinical outcomes, only the additional work can answer whether CTOs drive people away from services and whether potential clinical gains are sustained over time. Moreover, the full data set will inform decision making in a context where potential disengagement and clinical outcomes may interplay. For example, if we find that CTOs lead to increased disengagement with services, clinicians may wish to put in place strategies to minimise this, but may still wish to use CTOs if they lead to significant reductions in readmission rates.