Impact of compulsory community treatment on admission rates: survival analysis using linked mental health and offender databases.
BACKGROUND
There is controversy as to whether compulsory community treatment for psychiatric patients reduces hospital admission rates.


OBJECTIVE
To examine whether community treatment orders (CTOs) reduce admission rates, using a two-stage design of matching and multivariate analyses to take into account socio-demographic factors, clinical factors, case complexity and previous psychiatric and forensic history.


METHODS
Survival analysis of CTO cases and controls from three linked Western Australian databases of health service use, involuntary treatment and forensic history. We used two control groups: one matched on demographic characteristics, diagnosis, past psychiatric history and treatment setting, and consecutive controls matched on date of discharge from in-patient care.


RESULTS
We matched 265 CTO cases with 265 matched controls and 224 consecutive controls (total n=754). The CTO group had a significantly higher readmission rate: 72% v. 65% and 59% for the matched and consecutive controls (log-rank chi(2)=4.7, P=0.03). CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were associated with increased admission rates.


CONCLUSIONS
Community treatment orders alone do not reduce admissions.
Kisely
Stephen R
SR
University Department of Psychiatry at Fremantle Hospital, University of Western Australia, Australia. Stephen.Kisely@cdha.nshealth.ca
Xiao
Jianguo
J
Preston
Neil J
NJ
D000328:Adult; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D005260:Female; D005555:Forensic Psychiatry / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D014904:Western Australia / Q000453:epidemiology