BackgroundThere is controversy as to whether compulsory community treatment for psychiatric patients reduces hospital admission rates.AimsTo 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.MethodSurvival 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-patient care.ResultsWe matched 265 CTO cases with 265 matched controls and 224 consecutive controls (totaln=754). The CTO group had a significantly higher readmission rate: 72%v.65% and 59% for the matched and consecutive controls (log-rank χ2=4.7,P=0.03). CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were associated with increased admission rates.ConclusionsCommunity treatment orders alone do not reduce admissions.
Compulsory Community Treatment? I. Ontario Stakeholders' Responses to “Helping those Who Won't Help Themselves”