Community Treatment Orders: relationship to clinical care, medication compliance, behavioural disturbance and readmission

Vaughan, Kevin; McConaghy, Nathaniel; Wolf, Cherry; Myhr, Craig; Black, Terry

doi:10.1046/j.1440-1614.2000.00813.x

Cited by 43 publications

(85 citation statements)

References 10 publications

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“…The CTO also affords the service provider to take action if the patient does not present. These findings are consistent with studies from other jurisdictions that demonstrate increased use of community services for patients on CTOs (Segal and Burgess 2006;Appelbaum 2005;Dawson and Romans 2001;Vaughan et al 2000;Swartz et al 1999).…”

Section: Discussionsupporting

confidence: 90%

“…Many scholars have identified the need to move beyond hospital utilization rates as a measure of efficacy (Dawson et al 2003;Brophy et al 2006;Hunt et al 2007). Some studies have included other outcome measures (Swartz et al 1999;Dawson and Romans 2001;Vaughan et al 2000;Hiday et al 2001). One American study explored the relationship between involuntary outpatient commitment and homelessness, (Compton et al 2003).…”

Section: Literature Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Community Treatment Orders: Beyond Hospital Utilization Rates Examining the Association of Community Treatment Orders with Community Engagement and Supportive Housing

O'Brien

Farrell

Faulkner

2009

Community Ment Health J

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The purpose of this paper is to examine the association of community treatment orders (CTO) with community engagement and housing arrangements for one population of psychiatric patients in Ontario, Canada. Socio demographic characteristics and health service utilization information were collected for each patient placed on a CTO during a 3 year period. Information was collected for each of the 84 patients when a CTO was first issued and then updated to reflect both the patient's ongoing involvement with the legislation and related clinical outcomes. A significant increase in the number of community services and a shift to supportive housing arrangements was found for patients following issuance of a CTO.

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Section: Discussionsupporting

confidence: 90%

Section: Literature Reviewmentioning

confidence: 99%

Community Treatment Orders: Beyond Hospital Utilization Rates Examining the Association of Community Treatment Orders with Community Engagement and Supportive Housing

O'Brien

Farrell

Faulkner

2009

Community Ment Health J

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“…The outcomes measures which have been used in the review of success of CMOs in the general community have tended to focus on the use of health services, such as readmission data, length of stay, and outpatient contacts. Vaughan, McConaghy, Wolf, Myhr and Black (2000) also looked at the effect of a Community Treatment Order (CTO) on compliance with medication. They examined CTO outcomes in 123 patients on CTOs in NSW and found that while on CTOs patients receiving depot medications showed high compliance, and significantly reduced readmission rates.…”

Section: Discussionmentioning

confidence: 99%

Involuntary Mental Health Treatment in the Remote Northern Territory

Nagel

2003

Psychiatry, Psychology and Law

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“…Community treatment orders (CTOs) are used in Australia [9,10] and Canada [6] and give mental health professionals the right to place an individual on an order, whether they are in hospital or not. This is in contrast to extended leave or supervised discharge, which only applies to patients who are being discharged from inpatient care [6].…”

Section: Are We Assessing the Same Intervention?mentioning

confidence: 99%

Methodological Issues in Assessing the Evidence for Compulsory Community Treatment

Kisely¹,

Campbell²

2007

CPSR

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There is controversy as to whether compulsory community treatment (CCT) reduces health service use, or improves clinical outcome and social functioning. Given the widespread use of such powers in North America, Europe and Australasia, it is important to assess the benefits and potential harms of this type of legislation. Unfortunately, evidence for their effectiveness remains weak. In our Cochrane systematic review we were only able to identify two randomised controlled trials, and neither study showed any significant reductions in readmission rates, bed-days or arrests for cases on compulsory community treatment compared to appropriate controls. In terms of the number needed to treat (NNT), it would take up to 100 treatment orders to prevent one readmission, 25 to prevent one episode of homelessness and 500 to prevent one arrest. Including other study designs such as controlled before and after (CBA) studies made little difference to the results (total n=1108). There are other concerns for patients. This legislation stigmatises individuals with a severe mental illness, as many of these initiatives are named after a high profile victim of someone who happened to have a psychiatric illness. New York has a 'Kendra's Law', California a 'Laura's Law', and Ontario a 'Brian's Law'. Compulsory community treatment appears to be immune from evidence-based practice, possibly because of the convenience of legislative as opposed to evidence-based solutions such as assertive community treatment.

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Community Treatment Orders: relationship to clinical care, medication compliance, behavioural disturbance and readmission

Cited by 43 publications

References 10 publications

Community Treatment Orders: Beyond Hospital Utilization Rates Examining the Association of Community Treatment Orders with Community Engagement and Supportive Housing

Community Treatment Orders: Beyond Hospital Utilization Rates Examining the Association of Community Treatment Orders with Community Engagement and Supportive Housing

Involuntary Mental Health Treatment in the Remote Northern Territory

Methodological Issues in Assessing the Evidence for Compulsory Community Treatment

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