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Impact of compulsory community treatment on admission rates

Survival analysis using linked mental health and offender databases

University Department of Psychiatry at Fremantle Hospital, University of Western Australia, Fremantle

Jianguo Xiao, PhD

Health Information Centre, Health Department of Western Australia, East Perth

Neil J. Preston, MSc

Mental Health Directorate, Fremantle Hospital and Health Service, Fremantle, Western Australia

Correspondence: Professor Stephen Kisely, Department of Psychiatry, Dalhousie University, Abbie J. Lane Memorial Building, 5909 Veteran’s Memorial Lane, Suite 9211, Halifax, Nova Scotia B3H 2E2, Canada. Tel: +1 902 473 7356; fax: +1 902 473 4887; e-mail: Stephen.Kisely{at}cdha.nshealth.ca

Declaration of interest None. Funding detailed in Acknowledgement.

Background There is controversy as to whether compulsory community treatment for psychiatric patients reduces hospital admission rates.

Aims To examine whether community treatment orders (CTOs) reduce admission rates, using a two-stage design of matching and multivariate analyses to take into account socio-demographic factors, clinical factors, case complexity and previous psychiatric and forensic history.

Method Survival analysis of CTO cases and controls from three linked Western Australian databases of health service use, involuntary treatment and forensic history. We used two control groups: one matched on demographic characteristics, diagnosis, past psychiatric history and treatment setting, and consecutive controls matched on date of discharge from in-patientcare.

Results We matched 265 CTO cases with 265 matched controls and 224 consecutive controls (total n=754). The CTO group had a significantly higher readmission rate: 72% v. 65% and 59% for the matched and consecutive controls (log-rank ²=4.7, P=0.03). CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were associated with increased admission rates.

Conclusions Community treatment orders alone do not reduce admissions.

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Highlights of this issue

BJP 2004 184: 379-a19. [Full Text]  

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				A. Gibbs, J. Dawson, and R. Mullen Community Treatment Orders for People with Serious Mental Illness: A New Zealand Study Br. J. Soc. Work, October 1, 2006; 36(7): 1085 - 1100. [Abstract] [Full Text] [PDF]

				J. Robinson, T. Mahmood, and S. Kisely Compulsory community treatment and admission rates * Author's reply The British Journal of Psychiatry, December 1, 2004; 185(6): 519 - 520. [Full Text] [PDF]