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Results from the largest randomized, double-blind trial of compulsory outpatient treatment yet conducted show that the intervention — while dramatically increasing the amount of time an individual is subjected to compulsory medical interventions (and deprived of essential liberties) — does not reduce hospital readmissions or improve social/clinical outcomes when compared to inpatient hospitalization.

Researcher, former proponent of compulsory outpatient treatments says they “don’t work” and calls for moratorium.

Date Published:

Apr 14, 2013 12:00 AM

Author: Tom Burns

Source: the Lancet

Compulsory outpatient treatment is known in the United States as “Assisted Outpatient Treatment” [AOT] and in the United Kingdom as “Community Treatment Order” [CTO]. Laws about implementation vary, but the practice generally allows for individuals with a mental health diagnosis living in the community to be compelled to attend medical appointments and adhere to medication regimes for a period of time much longer than inpatient hospitalization (in the UK a CTO can be enacted for 6 months, with the possibility of renewal). In many areas, compulsory outpatient treatment also makes possible forced injections of long-acting antipsychotic medications in the individual’s home.

Says the lead author of the study, Tom Burns of Oxford University: "the evidence is staring us in the face that CTOs don't workI think there should be a moratorium on their use at least for a year or so while we think through how we can improve on the quality of evidence we've got. If we can't do that I think it really is unjustified to continue to use them.”

Proponents of compulsory outpatient treatment claim that the practice will stop the cycle of frequent hospital readmissions for individuals dealing with mental/emotional distress (such as “psychosis”) by ensuring medication compliance. In England and Wales, compulsory outpatient treatment was legislated for this specific reason. But according to Burns, “Despite a more than three-fold increase in time under initial supervised community care, the rate of readmission to hospital was not decreased by CTOs. Neither was the time to readmission decreased nor was there any significant difference in the number or duration of hospital admissions.”

This is the third major study to demonstrate these results. After a 20-year career of supporting CTOs, Burns now writes, “The evidence is now strong that the use of CTOs does not confer early patient benefits despite substantial curtailment of individual freedoms.”

Download the results of Burns’ research (as published in the prestigious medical journal The Lancet) here, and read an article/interview of Burns here.


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First involuntarily institutionalized, at 15, Lauren Tenney is a survivor of psychiatry. She has been involved with the user and survivor movement since 1992. Her goal is to help stop forced psychiatric procedures, detainment, and confinement, human rights violations, psychiatric abuse and torture. Of particular concern are the elimination of forced electroconvulsive treatment (ECT) on people of all ages, but particularly children and senior citizens, forced drugging, restraints, seclusion, behavioral interventions, and coercion of any kind. Lauren, a Mad-Activist/ Artist/ Author/ Academic/ Adjunct Professor is coordinating The Opal Project, an outcome of participatory action research she coordinated for field research in the PhD program in Environmental Psychology at the Graduate Center, CUNY. Her dissertation topic is: "The Institutionalized "Community." She became involved with WE THE PEOPLE when the Law Project for Psychiatric Rights and MindFreedom International needed someone on the ground in Brooklyn, New York to coordinate a response where Esmin Green was murdered-by-neglect. She now lives in Albany, NY with her service dog-in-training and cat. For more info: and
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