Assessing the outcome of compulsory treatment orders on management of psychiatric patients at 2 McGill University-associated hospitals.
OBJECTIVE
Some literature suggests that compulsory community treatment orders (CTOs) are effective in reducing hospitalizations in a subgroup of psychiatric patients with histories of repeated hospitalization, allowing them to be treated in the community under less restrictive measures. However, studies have yielded contradictory findings, in part because of methodological differences. Our study examines the effectiveness of CTOs in reducing hospitalizations and increasing community tenure of such patients.


METHODS
The sample included all psychiatric patients who had been given a CTO during a 9-year period at 2 of McGill University's hospitals. This is a naturalistic, observational, retrospective, before-and-after study where patients acted as their own control subjects. We examined variables, including the number, duration, and time to psychiatric admissions, comparing 4 time periods: early, pre-index, index (when the first CTO was in force), and post-index periods. The total study duration per subject encompasses the longest period of observation within existing studies in Canada.


RESULTS
Psychiatric patients with histories of frequent readmissions demonstrated a significant reduction in their number of hospitalizations as well as an increase in the median time to re-hospitalization, during the period when they were treated under a CTO. This effect of CTO was sustained even after the CTO had expired.


CONCLUSIONS
Our study suggests that CTOs are effective in assisting psychiatric patients with histories of repeated hospitalizations to live and be treated in the community, diminishing the occurrence of frequent hospitalization.
McGill University, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada.
Arash
A
Nakhost
John Christopher
JC
Perry
Daniel
D
Frank
D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D003156:Community Mental Health Services / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007298:Insanity Defense; D053208:Kaplan-Meier Estimate; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D010359:Patient Readmission / Q000706:statistics & numerical data; D010554:Personality Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D011329:Prisoners / Q000523:psychology*; D011567:Psychiatric Department, Hospital; D011618:Psychotic Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D011792:Quebec; D012189:Retrospective Studies; D012559:Schizophrenia / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome