Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers community treatment orders (CTOs) and assertive community treatment (ACT) teams in the context of schizophrenia treatment with Dr. Arash Nakhost a staff psychiatrist who works on the FOCUS ACT team at St. Michael’s Hospital.

The learning objectives for this episode are as follows:

By the end of this episode, the listener will be able to…

1. Provide a brief description of the history of ACT teams and CTOs, as well as the challenges in establishing evidence for their use

2. Compare and contrast ACT teams with intensive case management teams in terms of their composition, methods, and respective strengths and weaknesses

3. Describe the array of services that an ACT team can help provide to its clients as well as some of the challenges and drawbacks of ACT teams

4. Outline the major reasons someone might be put on a community treatment order and describe how a CTO is applied and enforced

5. Outline the major challenges in using CTOs as a treatment tool

Guest staff psychiatrist: Dr. Arash Nakhost (St. Michael’s Hospital, Toronto)

References:

• Ontario Hospital Association. (2016). A practical guide to mental health and the law in Ontario. Government of Ontario, Health Care Consent Act.

• Kisely, S. R., Campbell, L. A., & O'Reilly, R. (2017). Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane database of systematic reviews, (3).

• Maughan, D., Molodynski, A., Rugkåsa, J., & Burns, T. (2014). A systematic review of the effect of community treatment orders on service use. Social psychiatry and psychiatric epidemiology, 49(4), 651-663.

• Aubry, T., Goering, P., Veldhuizen, S., Adair, C. E., Bourque, J., Distasio, J., ... & Tsemberis, S. (2015). A multiple-city RCT of housing first with assertive community treatment for homeless Canadians with serious mental illness. Psychiatric Services, 67(3), 275-281.

• Bromley, E., Mikesell, L., Whelan, F., Hellemann, G., Hunt, M., Cuddeback, G., ... & Young, A. S. (2017). Clinical factors associated with successful discharge from assertive community treatment. Community mental health journal, 53(8), 916-921.

CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.

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