Is the effect of compulsory community treatment on preventable deaths from physical disorders mediated by better access to specialized medical procedures?
OBJECTIVE
Compulsory community treatment has been shown to reduce preventable deaths from physical disorders-these causes being up to 10 times more common than suicide in psychiatric patients. We investigated whether this was mediated by better access to specialized medical procedures.


METHODS
All patients on compulsory community treatment for over 11 years were compared with matched control subjects using linked administrative health data from Western Australia (state population of about 2.24 million). Outcomes were access to revascularization and other specialized procedures at 1-, 2-, and 3-year follow-up. Logistic regression was used to adjust for demographics, prior health service use, diagnosis, and length of psychiatric history.


RESULTS
There were 2757 patients and 2687 control subjects (total n = 5444). Sixty-five per cent were males (n = 3522), and the average age was 36 years (SD 13.2). Most had schizophrenia or other nonaffective psychoses (74%), followed by affective disorders (26%). At 2-year follow-up, 2% (n = 53) of patients and 2.6% (n = 69) of control subjects had undergone a specialized intervention. Compulsory community treatment did not result in greater access to specialized procedures at all 3 time points even after adjusting for potential confounders.


CONCLUSIONS
Greater access to specialized procedures does not explain the reduced mortality from preventable physical illness that had been reported in patients on community treatment orders. There must be other explanations for this finding, such as mental health staff facilitating access to chronic disease management in primary care. This warrants further research.
Professor, University of Queensland, School of Medicine, Herston, Australia; Professor, Departments of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia.
Steve
S
Kisely
Epidemiologist, Department of Health, Health Department of Western Australia, Perth, Australia.
Jianguo
J
Xiao
Professor, Centre for Child Health Research, The University of Western Australia, Perth, Australia.
David
D
Lawrence
Analyst, Department of Health, Health Department of Western Australia, Perth, Australia.
Le
L
Jian
D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology* / Q000628:therapy; D003134:Commitment of Persons with Psychiatric Disorders / Q000592:standards / Q000706:statistics & numerical data*; D003156:Community Mental Health Services / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
community treatment order; mortality; psychiatric services