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Evaluating the effects of Community Treatment Orders (CTOs) in England using the Mental Health Services Dataset (MHSDS): protocol for a national, population-based study

Evaluating the effects of Community Treatment Orders (CTOs) in England using the Mental Health Services Dataset (MHSDS): protocol for a national, population-based study
Evaluating the effects of Community Treatment Orders (CTOs) in England using the Mental Health Services Dataset (MHSDS): protocol for a national, population-based study
Introduction: supervised Community Treatment (SCT) for people with serious mental disorders has become accepted practice in many countries around the world. In England, SCT was adopted in 2008 in the form of Community Treatment Orders (CTOs). CTOs have been used more than expected, with significant variations between people and places. There is conflicting evidence about the effectiveness of SCT; studies based on randomised controlled trials (RCTs) have suggested few positive impacts, while those employing observational designs have been more favourable. Robust population-based studies are needed, because of the ethical challenges of undertaking further RCTs and because variation across previous studies may reflect the effects of socio-spatial context on SCT outcomes. We aim to examine spatial and temporal variation in the use, effectiveness and cost of CTOs in England through the analysis of routine administrative data.

Methods and analysis: four years of data from the Mental Health Services Dataset (MHSDS) will be analysed using multilevel models (MMs). Models based on all patients eligible for CTOs will be used to explore variation in their use. A subset of CTO-eligible patients comprising a treatment group (CTO-patients) and a matched control group (non-CTO patients) will be used to examine variation in the association between CTO use and study outcomes. Primary outcome will be total time in hospital. Secondary outcomes will include time to first re-admission and mortality. Outputs from these models will be used to populate predictive models of health care resource use.

Ethics and dissemination: ethical approval has been granted by the NHS Data Access and Advisory Group and Warwick University. To ensure patient confidentiality and to meet data governance requirements, analyses will be carried out in a secure micro-data laboratory using de-identified data. Study findings will be disseminated through academic channels and shared with mental health policy makers and other stakeholders.
Community treatment orders; Supervised community treatment; Community mental health
2044-6055
Weich, Scott
5c727606-6cf5-46e6-a6ea-c5c02ac201d9
Duncan, Craig
3ba34681-49b4-4192-8d71-6eb5b7434b64
Bhui, Kamaldeep
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Canaway, Alastair
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Crepaz-Keay, David
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Keown, Patrick
24d97ff6-781b-4ce7-8458-a72ca307a887
Madan, Jason
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McBride, Orla
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Moon, Graham
68cffc4d-72c1-41e9-b1fa-1570c5f3a0b4
Parsons, Helen
564bb878-68c8-44e7-ba7c-57c748dc380a
Singh, Swaran
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Twigg, Liz
1211e187-dbf0-4af8-9c07-f1abefab3698
Weich, Scott
5c727606-6cf5-46e6-a6ea-c5c02ac201d9
Duncan, Craig
3ba34681-49b4-4192-8d71-6eb5b7434b64
Bhui, Kamaldeep
03b3537e-946a-44cf-955c-449625685897
Canaway, Alastair
40eb8e0a-befe-4ddb-80cb-93896c405499
Crepaz-Keay, David
97b458c2-a07b-4f22-9e04-03b37cfea12a
Keown, Patrick
24d97ff6-781b-4ce7-8458-a72ca307a887
Madan, Jason
a7783259-b0a8-4c29-aafe-c7d9ddd18d37
McBride, Orla
85f1277c-a0b7-4812-bcf7-ae4c7a6f8c46
Moon, Graham
68cffc4d-72c1-41e9-b1fa-1570c5f3a0b4
Parsons, Helen
564bb878-68c8-44e7-ba7c-57c748dc380a
Singh, Swaran
d9c6bf9b-0896-4a5f-b6d0-70a4e96f348d
Twigg, Liz
1211e187-dbf0-4af8-9c07-f1abefab3698

Weich, Scott, Duncan, Craig, Bhui, Kamaldeep, Canaway, Alastair, Crepaz-Keay, David, Keown, Patrick, Madan, Jason, McBride, Orla, Moon, Graham, Parsons, Helen, Singh, Swaran and Twigg, Liz (2018) Evaluating the effects of Community Treatment Orders (CTOs) in England using the Mental Health Services Dataset (MHSDS): protocol for a national, population-based study. BMJ Open. (In Press)

Record type: Article

Abstract

Introduction: supervised Community Treatment (SCT) for people with serious mental disorders has become accepted practice in many countries around the world. In England, SCT was adopted in 2008 in the form of Community Treatment Orders (CTOs). CTOs have been used more than expected, with significant variations between people and places. There is conflicting evidence about the effectiveness of SCT; studies based on randomised controlled trials (RCTs) have suggested few positive impacts, while those employing observational designs have been more favourable. Robust population-based studies are needed, because of the ethical challenges of undertaking further RCTs and because variation across previous studies may reflect the effects of socio-spatial context on SCT outcomes. We aim to examine spatial and temporal variation in the use, effectiveness and cost of CTOs in England through the analysis of routine administrative data.

Methods and analysis: four years of data from the Mental Health Services Dataset (MHSDS) will be analysed using multilevel models (MMs). Models based on all patients eligible for CTOs will be used to explore variation in their use. A subset of CTO-eligible patients comprising a treatment group (CTO-patients) and a matched control group (non-CTO patients) will be used to examine variation in the association between CTO use and study outcomes. Primary outcome will be total time in hospital. Secondary outcomes will include time to first re-admission and mortality. Outputs from these models will be used to populate predictive models of health care resource use.

Ethics and dissemination: ethical approval has been granted by the NHS Data Access and Advisory Group and Warwick University. To ensure patient confidentiality and to meet data governance requirements, analyses will be carried out in a secure micro-data laboratory using de-identified data. Study findings will be disseminated through academic channels and shared with mental health policy makers and other stakeholders.

Text
CTO Protocol Paper - Main Text v4.0 - BMJOpenclean copy - Accepted Manuscript
Available under License Creative Commons Attribution.
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More information

Accepted/In Press date: 18 August 2018
Keywords: Community treatment orders; Supervised community treatment; Community mental health

Identifiers

Local EPrints ID: 424206
URI: https://eprints.soton.ac.uk/id/eprint/424206
ISSN: 2044-6055
PURE UUID: d15bafc9-126c-4a36-b4e6-2167acc8244f
ORCID for Graham Moon: ORCID iD orcid.org/0000-0002-7256-8397

Catalogue record

Date deposited: 05 Oct 2018 11:34
Last modified: 14 Mar 2019 01:41

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Contributors

Author: Scott Weich
Author: Craig Duncan
Author: Kamaldeep Bhui
Author: Alastair Canaway
Author: David Crepaz-Keay
Author: Patrick Keown
Author: Jason Madan
Author: Orla McBride
Author: Graham Moon ORCID iD
Author: Helen Parsons
Author: Swaran Singh
Author: Liz Twigg

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