An eleven-year evaluation of the effect of community treatment orders on changes in mental health service use

Kisely, Steve, Preston, Neil, Xiao, Jianguo, Lawrence, David, Louise, Sandra, Crowe, Elizabeth and Segal, Steven (2013) An eleven-year evaluation of the effect of community treatment orders on changes in mental health service use. Journal of Psychiatric Research, 47 5: 650-656. doi:10.1016/j.jpsychires.2013.01.010

Author Kisely, Steve
Preston, Neil
Xiao, Jianguo
Lawrence, David
Louise, Sandra
Crowe, Elizabeth
Segal, Steven
Title An eleven-year evaluation of the effect of community treatment orders on changes in mental health service use
Journal name Journal of Psychiatric Research   Check publisher's open access policy
ISSN 0022-3956
Publication date 2013-05-01
Sub-type Article (original research)
DOI 10.1016/j.jpsychires.2013.01.010
Volume 47
Issue 5
Start page 650
End page 656
Total pages 7
Place of publication Kidlington, Oxford, United Kingdom
Publisher Pergamon
Collection year 2014
Language eng
Abstract Many studies of compulsory community treatment have assessed their effect early on after the implementation of legislation. Although compulsory community treatment may not prevent readmission to hospital, there is evidence of an effect on length of stay before and after the intervention when compared to controls. This paper examines whether outcomes change as clinicians gain experience in the use of community treatment orders (CTOs). Cases and controls from three linked Western Australian databases were matched on age, sex, diagnosis and time of hospital discharge or community placement. We compared changes in bed-days and outpatient visits of CTO cases and controls using multivariate analyses to further control for confounders. We identified 2958 CTO cases and controls from November 1997 to December 2008 (total n = 5916). The average age was 37 years and 64% were male. Schizophrenia and other non-affective psychoses were the commonest diagnoses (73%). CTO placement was associated with a mean decrease of 5 bed-days from before the order when compared to controls (B = -5.23, s.e. = 1.60, t = -3.26, p < 0.001). There was an increase of 8 days in outpatient contacts (B = 8.31, s.e. = 1.17, t = 7.11, p < 0.001). There was little change in CTO use and outcomes over the 11 years. Compared to controls, CTOs may therefore reduce lengths of stay from before placement on the order. They also increase outpatient contacts. This study illustrates the importance of selecting an outcome that directly addresses the objective of the intervention.
Keyword Community treatment orders
Supervised community treatment
Outpatient commitment
Compulsory community treatment
Severe mental illness
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
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