Evidence-Based Practice in Use of CTOs

Drs Karagianis, Hastings, and Gray disagree with our assessment of the evidence on the effectiveness of community treatment orders (CTOs). In our reviews of studies from Canada and abroad, we apply recognised principles of evidence-based medicine (EBM) to assess the quality of the research. We found some studies show therapeutic benefits for CTOs. These include studies commissioned by governments, often conducted by nonacademic consultancies and not subject to peer review, and a number of small-scale, uncontrolled studies. These are the kinds of studies conducted in Canada. They do not provide robust evidence for efficacy of CTOs, especially when few high-quality studies report positive outcomes, and all the randomized studies and the best nonrandomized ones find no evidence of therapeutic benefit.