As Robinson & Mahmood point out the crucial issue in our paper is the comparability of those patients who were on community treatment orders (CTOs) and those who were not. Although we controlled for sociodemographic variables, clinical features, case complexity and psychiatric history, we fully acknowledged in our paper that there may have been additional factors that we could not control for in the analysis. These might include social disability, aggression not resulting in a forensic history, medication type (including the use of depot preparations) and characteristics of the clinician, treating team or service. Inevitably, a study that took these factors into account would be restricted to one or two services with consequent loss of statistical power and the dangers of selection or referral bias. Furthermore, our study was able to adjust for more service use confounders than others that have shown positive effects of compulsory community treatment (Reference BindmanBindman, 2002).

However, we disagree that patients who had been discharged from a CTO by a Mental Health Review Board would be a more appropriate control group. Even with careful matching, there would be a reason why the intervention group remained on a CTO while the controls were discharged from their order. For instance, patients who remained on compulsory community treatment could have been less insightful about their illness or more likely to have a history of aggressive behaviour. Neither can we accept that surveys of psychiatrists’ views on CTOs have any place in an era of evidence-based practice. This would not be accepted as a reason to introduce any other psychiatric intervention. Why should CTOs with their attendant implications for the civil liberties of patients be treated differently?