Changes in determinants of compulsory community treatment over 11 years. A population-based analysis of linked mental health databases

Abstract

Changes in determinants of compulsory community treatment over 11 years. A populationbased analysis of linked mental health databases, Psychiatry Research, http://dx.doi.org/10.1016/j.psychres. 2015.09.027 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 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.

A systematic review and meta-analysis of predictors and outcomes of community treatment orders in Australia and New Zealand

“…The second was of CTOs in Western Australia in the year prior and following their implementation from 1998 to 1999 (Kisely et al, 2004; Preston et al, 2002; Segal et al, 2009; Xiao et al, 2004). This was later extended till 2011 (Kisely et al, 2013a, 2013b, 2014a, 2014b, 2015; Kisely and Xiao, 2017). The third study was again of Victorian administrative data, this time from 2000 to 2010 (Segal et al, 2017a, 2017b, 2018, 2019).…”

“…In terms of diagnosis, patients with schizophrenia or non-affective psychosis were significantly more likely to be on a CTO (Bardell-Williams et al, 2019; Kisely et al, 2013a, 2015, 2020; Segal and Burgess, 2006a; Segal et al, 2017a). However, it was not possible to meta-analyse whether particular psychiatric disorders were associated with CTO placement because of the wide range of ways they were classified.…”

“…By contrast, Indigenous patients were not at greater risk of CTO placement even after controlling for sociodemographic variables and rural residence despite the higher rates of involuntary psychiatric admission in this population (Nagel, 2003). The reasons for this are unclear but one possibility is the limited availability of appropriate services to actually administer a CTO in non-urban areas (Kisely et al, 2015).…”

Une analyse critique des effets de l’autorisation judiciaire de soins sur la dynamique relationnelle entre la personne visée et ses systèmes de soutien

“…Bien que l'application de cette mesure puisse être déterminante sur le rétablissement de la personne et justifi ée par un critère de nécessité, l'augmentation de son utilisation à l'échelle internationale exige une analyse éthique, clinique et juridique de ses usages. [5,9,13] Il est utile de rappeler que c'est avant tout l'environnement de soins et l'intensité des services offerts, plutôt que la coercition, qui constituerait un déterminant du processus de rétablissement. [5] À l'inverse, il semble fi nalement important d'étudier comment l'accès à de tels services en temps opportun peut infl uencer la perception des différents acteurs à l'égard de l'autorisation judiciaire de soins.…”

“…[9] Malgré que l'effi cacité de l'autorisation judiciaire de soins soit présentement contestée, [5,7,9] le recours à une telle mesure d'exception est pourtant en augmentation à l'échelle internationale. [13] Cette augmentation soulève donc de nombreuses questions d'ordre éthique et clinique.…”