Compulsory community and involuntary outpatient treatment for people with severe mental disorders

Abstract

Compulsory community treatment results in no significant difference in service use, social functioning or quality of life compared with standard care. People receiving compulsory community treatment were, however, less likely to be victims of violent or non-violent crime. It is unclear whether this benefit is due to the intensity of treatment or its compulsory nature. Evaluation of a wide range of outcomes should be considered when this type of legislation is introduced.

Reducing all-cause mortality among patients with psychiatric disorders: a population-based study

“…9,10 Finally, the results were not adjusted for patients' marital status, education, country of birth, indigenous status or use of health services before the introduction of community treatment orders. Adjusting for these variables could reduce the bias inherent in drawing cases and controls from the same jurisdiction given the difficulties in controlling for all possible reasons for issuing these orders once they have been introduced.…”

“…These orders are used across both Canada and Australia, are of similar duration in both countries, and are clinician-initiated rather than court-ordered (in contrast to the United States). 10,11 Unlike in Canada, patients in Australia can be given community treatment orders without having been previously admitted to hospital. In practice, patients in both countries spend similar amounts of time in hospital before being given a community treatment order.…”

Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial

“…We chose the rate of readmission as our primary outcome, and powered our trial on it, because CTOs have been legislated explicitly for this outcome, and it is also the primary outcome in most major studies, 10,11,18 including the only two published randomised trials (panel). 12,13 The total number of days in psychiatric hospital was very similar for both groups in our trial, as was the time from randomisation to initial discharge.…”

Involuntary admission and treatment of patients with mental disorder

“…Early involuntary community programs were seen as a means to provide a less restrictive alternative to hospitalization and to increase individual autonomy. It is not clear if community compulsory care offers advantages or disadvantages in terms of outcomes, such as subsequent service use, social functioning, quality of life, or cost-effectiveness [23] .…”