Benefits following community treatment orders have an inverse relationship with rates of use: meta-analysis and meta-regression

Abstract

Background Community treatment order (CTO) use in Australia and New Zealand ranges from less than 40 per 100 000 population in Western Australia and Canterbury to over 100 per 100 000 in Victoria, South Australia and Waitemata. Recent publications on CTO use now permit a meta-regression to investigate whether differences in CTO use by jurisdiction affect either the possible predictors or outcomes of CTOs. Aims To assess whether factors associated with CTO placement or subsequent outcomes vary by rates of use. Method A systematic search of PubMed/Medline, Embase, CINAHL, the Cochrane Central Register of Controlled Trials and PsycINFO for any Australian or New Zealand study comparing CTO cases with controls receiving voluntary psychiatric treatment. This study was prospectively registered with PROSPERO (protocol registration number: CRD42022351500). Results There were 35 articles from 16 studies identified in the search, plus unpublished data from a further study. Of these, 29 publications were included in meta-analyses. Two were from New Zealand. People who were male, single and not engaged in work, study or home duties were significantly more likely to be on CTOs. In addition, those from migrant backgrounds were 47% more likely to be on an order. On meta-regression, cases in jurisdictions with higher CTO rates had higher proportions of females or individuals with diagnoses other than non-affective psychoses. High-use jurisdictions were also less likely to show reductions in readmission rates or bed-days. Conclusions There are marked differences in the possible predictors and outcomes of CTO placement between high- and low-use jurisdictions in Australia and New Zealand. These findings may have implications elsewhere and indicate that better-targeted CTO placement might improve outcomes.

Compulsory community treatment orders (CTOs): recent research and future directions

“…There is evidence that clinicians adapt to changing legislation and patients with the most severe illnesses (associated with risks or lack of capacity) continue to be treated compulsorily despite legislative change. 14 However, we also believe that recent research, such as Kisely et al's excellent analysis, 10 is assisting the field by informing which outcomes different patient groups are likely to experience on CTOs and that this will improve care for patients and families.…”

“…Benefits following community treatment orders have an inverse relationship with rates of use: a meta-analysis and meta-regression by Kisely et al in a recent issue of the BJPsych Open is important because it provides clues on which patient groups may benefit from compulsory treatment. 10 CTO use in Australasia was examined to evaluate whether factors associated with CTO use or subsequent outcomes vary according to rates of use. Kisely et al confirm the well-established finding that CTO use varies substantially between regions.…”

We have to cancel psychiatric nursing and forge a new way forward

“…The negative effects of restrictive practices are not just confined to the hospital setting. A meta-analysis and meta-regression of community treatment order (CTO) usage conducted by Kisely et al (2023) found there is no evidence that CTOs reduce bed-days or admissions or that they address the issue of the 'revolving door'. Moreover, the review found that people from a migrant background were 47% more likely to be subjected to CTOs.…”