Canadian Studies on the Effectiveness of Community Treatment Orders: An Updated Systematic Review of Quantitative Data: Études canadiennes sur l'efficacité des ordonnances de traitement en milieu communautaire : mise à jour d'un examen systématique des données quantitatives.

Abstract

ObjectivesCommunity treatment orders (CTOs) for people with severe mental illnesses are used across most of Canada. Our previous systematic review of 10 years ago found that the evidence-base was limited to small studies, with only one including controls. This review updates the evidence using studies conducted in Canada over the last decade.MethodsA systematic search of PubMed/Medline, Embase, CINAHL, and PsycINFO for any Canadian study of outcomes following CTO placement from March 2015 to January 2025.ResultsWe identified four articles from three studies. Adding these studies to the previous search gave a total of nine articles from seven studies. None could be included in a meta-analysis. There were reductions in readmission rates and bed-days following CTO placement, while psychiatric symptom, outpatient attendance, treatment adherence participation in psychiatric services and housing all improved. In one study, perceived coercion was no greater in the CTO cases than the controls and being on an order preferable to being in hospital. However, many of the studies were small and only two included controls, of which solely one adjusted for potential confounders using either matching or adjusted analyses. The certainty of evidence was therefore rated as very low.ConclusionsThe evidence-base for the use of CTOs in Canada remains limited. This research gap contrasts with other countries that have conducted large studies using randomized or matched controls and adjusted analyses. There is a need for larger studies with more standardized reporting methods to allow for the pooling of results.Protocol Registration NumberProspectively registered with PROSPERO registration number CRD42024615480.