title: Changes in determinants of compulsory community treatment over 11 years. A population-based analysis of linked mental health databases.
abstract: Differences in patient characteristics, legislation and service setting may explain variations in the reported efficacy of compulsory treatment orders (CTOs). Our objective was to investigate factors associated with CTO placement in Western Australia and see if there were any changes over the 11 years following their introduction. We used three linked Western Australian databases to compare 2958 patients on community treatment orders with an equal number of controls matched on age, sex and diagnosis, as well as 2832 consecutive controls selected on date of discharge from inpatient care or CTO placement. Multivariate analyses were used to further examine potential predictors of a CTO. The incidence of CTOs, and the characteristics of patients placed on these orders, showed little change over 11 years. They tended to be younger and male with schizophrenia or other non-affective psychotic disorders. Previous health service use as an inpatient or outpatient also predicted compulsory community treatment. Psychiatrists in Western Australia appear to be applying community treatment orders to similar types of patient as elsewhere, but unlike other jurisdictions, use has not increased. We need further research to establish the relative contribution of patient characteristics, legislation and service setting toward the use and outcome of CTOs.
authors.affiliation: University of Queensland, School of Medicine, Level 4, Building 1, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia; Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia. Electronic address: s.kisely@uq.edu.au.
authors.forename: Steve
authors.initials: S
authors.lastname: Kisely
authors.affiliation: Department of Health, Western Australia, Perth, Australia.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Department of Health, Western Australia, Perth, Australia; School of Public Health, Curtin University, Perth, Australia.
authors.forename: Le
authors.initials: L
authors.lastname: Jian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003156:Community Mental Health Services / Q000331:legislation & jurisprudence / Q000639:trends*; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D037141:Mandatory Programs / Q000639:trends*; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health / Q000331:legislation & jurisprudence / Q000639:trends*; D008875:Middle Aged; D015999:Multivariate Analysis; D010045:Outpatients / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D013997:Time Factors; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
keywords: Community treatment orders; Compulsory community treatment; Epidemiology; Outpatient commitment