title: Rate of community treatment orders and readmission orders following reconfiguration of community mental health services.
abstract: OBJECTIVE
  Community treatment orders (CTOs) are a controversial practice as they extend the practice of involuntary treatment into the community. This study aimed to determine whether there was a difference in the rate of CTOs and revocation (readmission) orders following the implementation of a recovery-orientated model across four adult mental health services.
  
  
  METHODS
  A retrospective cohort study was conducted prior to and after the reconfiguration of services. Population data for those aged 15 to 65 were obtained from a census and rate rates were calculated.
  
  
  RESULTS
  Prior to the reconfiguration, there were 893 individuals subject to a CTO and 136 of these individuals had a revocation of their CTO (i.e. were involuntarily readmitted). This represented a rate of 100.8 individuals on CTOs per 100,000 population and a rate of 15.4 revocations per 100,000 population. Following the reconfiguration, the rate of CTOs increased by 10% and there was a trend for the rate of revocation orders to have decreased by 17%.
  
  
  CONCLUSIONS
  Rates of CTOs and readmissions varied across services and further research is warranted to identify factors associated with these increased rates. Additionally, the very high rate of CTOs in the catchment areas warrants further examination.
authors: Clinical Research Fellow, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia briannoelodonoghue@gmail.com.
authors: Brian
authors: B
authors: O'Donoghue
authors: Senior Research Fellow, The Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
authors: Lisa
authors: L
authors: Brophy
authors: Consultant Psychiatrist, Forensicare, Victorian Institute of Forensic Mental Health, Melbourne, VIC, Australia.
authors: Nicholas
authors: N
authors: Owens
authors: Senior Psychiatry Registrar, Orygen Youth Health Clinical Program, Melbourne, VIC, Australia.
authors: Milana
authors: M
authors: Rasic
authors: Manager Reform and Innovation, NorthWestern Mental Health Service, Melbourne, VIC, Australia.
authors: Belinda
authors: B
authors: McCullough
authors: Consultant Psychiatrist, NorthWestern Mental Health Service, Melbourne, VIC, Australia.
authors: Beatrice
authors: B
authors: Huang
authors: Executive Director, NorthWestern Mental Health Service, Melbourne, VIC, and; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.
authors: Ruth
authors: R
authors: Vine
authors: Professor of Mental Health Nursing, NorthWestern Mental Health Service, Melbourne, VIC, and; Australian Catholic University, Melbourne, VIC, Australia.
authors: Brian
authors: B
authors: McKenna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D000076083:Involuntary Treatment, Psychiatric / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014739:Victoria; D055815:Young Adult
keywords: coercion; community treatment orders; involuntary treatment; recovery-orientated services