Community treatment orders in Toronto: the emerging data.
OBJECTIVE
Over a 4-year period in Toronto, this study aimed to compare individuals on a community treatment order (CTO) with individuals not on a CTO in terms of sociodemographic and clinical variables, hospital use, and continued engagement with health services on exit from the case management program. Hospital stay reductions from preadmission into the program to various postadmission periods were compared across the 2 groups.


METHODS
Descriptive statistics and tests of statistical significance (chi-square and t test) were run on regularly collected administrative data for both groups.


RESULTS
Categorical data analysis indicated the 2 groups were statistically similar on a range of sociodemographic and clinical variables. Although both groups displayed reductions in hospital use, the CTO group displayed a significantly higher reduction in cumulative days in hospital per hospital admission within both the first and second 6-month period postadmission. This same group also had significantly greater reduction in hospital admissions during the second 6-month period postadmission. The CTO group also had a significantly higher portion of individuals exiting the program within these first two 6-month periods; as well, they were less likely to exit with support such as case management or assertive community treatment and more likely to continue with ongoing medical supervision than the comparison group.


CONCLUSIONS
Although we were unable to rule out regression to the mean for hospitalization reductions, the Toronto experience has shown that CTOs are helpful in assisting individuals who historically refused services to remain engaged with treatment and support services. The study also calls for broadening operational measures of outcomes for CTO studies.
Hunt
Alison M
AM
CTO Program, Canadian Mental Health Association, Toronto, Ontario. ahunt@cmha-toronto.net
da Silva
Angela
A
Lurie
Steve
S
Goldbloom
David S
DS
D000328:Adult; D002170:Canada; D019090:Case Management; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D003266:Continuity of Patient Care; D003710:Demography; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012944:Social Support