scholarly journals Suicide rates among patients subject to community treatment orders in England during 2009–2018

BJPsych Open ◽  
2021 ◽  
Vol 7 (6) ◽  
Author(s):  
Isabelle M. Hunt ◽  
Roger T. Webb ◽  
Pauline Turnbull ◽  
Jane Graney ◽  
Saied Ibrahim ◽  
...  
Keyword(s):  
Mental Health ◽  
Suicide Risk ◽  
Psychiatric Patients ◽  
Case Series ◽  
Population Based ◽  
Time Dependent ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Suicide Rates ◽  
Discharged Patients

Background Community treatment orders (CTOs) enable patients to be treated in the community rather than under detention in hospital. Population-based studies of suicide among patients subject to a CTO are scarce. Aims To compare suicide rates among patients subject to a CTO with all discharged psychiatric patients and those detained for treatment but not subject to a CTO at discharge (‘CTO-eligible’ patients). Method From a national case series of patients who died by suicide within 12 months of contact with mental health services in England during 2009–2018, we estimated average annual suicide rates for all discharged patients, those on a CTO at the time of suicide, those ever treated under a CTO and CTO-eligible patients. Results Suicide rates for patients on a CTO at the time of suicide (191.3 per 100 000 patients) were lower than all discharged patients (482.3 per 100 000 discharges). Suicide rates were similar in those ever treated under a CTO (350.1 per 100 000 CTOs issued) and in CTO-eligible patients (382.9 per 100 000 discharges). Suicide rates within 12 months of discharge were higher in persons ever under a CTO (205.1 per 100 000 CTOs issued) than CTO-eligible patients (161.5 per 100 000 discharges), but this difference was reversed for rates after 12 months of discharge (153.2 per 100 000 CTOs issued v. 223.4 per 100 000 discharges). Conclusions CTOs may be effective in reducing suicide risk. The relative benefits of CTOs and intensive aftercare may be time-dependent, with the benefit of a CTO being less before 12 months after discharge but greater thereafter. CTO utilisation requires a careful balancing of patient safety versus autonomy.

scholarly journals Evaluating the effects of community treatment orders (CTOs) in England using the Mental Health Services Dataset (MHSDS): protocol for a national, population-based study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e024193 ◽  
Author(s):  
Scott Weich ◽  
Craig Duncan ◽  
Kamaldeep Bhui ◽  
Alastair Canaway ◽  
David Crepaz-Keay ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Data Access ◽  
Population Based ◽  
Community Treatment ◽  
Spatial And Temporal Variation ◽  
Control Group ◽  
Advisory Group ◽  
Community Treatment Orders

IntroductionSupervised community treatment (SCT) for people with serious mental disorders has become accepted practice in many countries around the world. In England, SCT was adopted in 2008 in the form of community treatment orders (CTOs). CTOs have been used more than expected, with significant variations between people and places. There is conflicting evidence about the effectiveness of SCT; studies based on randomised controlled trials (RCTs) have suggested few positive impacts, while those employing observational designs have been more favourable. Robust population-based studies are needed, because of the ethical challenges of undertaking further RCTs and because variation across previous studies may reflect the effects of sociospatial context on SCT outcomes. We aim to examine spatial and temporal variation in the use, effectiveness and cost of CTOs in England through the analysis of routine administrative data.Methods and analysisFour years of data from the Mental Health Services Dataset (MHSDS) will be analysed using multilevel models. Models based on all patients eligible for CTOs will be used to explore variation in their use. A subset of CTO-eligible patients comprising a treatment group (CTO patients) and a matched control group (non-CTO patients) will be used to examine variation in the association between CTO use and study outcomes. Primary outcome will be total time in hospital. Secondary outcomes will include time to first readmission and mortality. Outputs from these models will be used to populate predictive models of healthcare resource use.Ethics and disseminationEthical approval has been granted by the National Health Service Data Access and Advisory Group and Warwick University. To ensure patient confidentiality and to meet data governance requirements, analyses will be carried out in a secure microdata laboratory using de-identified data. Study findings will be disseminated through academic channels and shared with mental health policy-makers and other stakeholders.

scholarly journals Impact of ethnicity, unemployment and economy on mental disorders : A study from Western Nepal

2014 ◽  
Vol 4 (1) ◽  
pp. 306-315
Author(s):  
Indrajit Banerjee ◽  
Indraneel Banerjee ◽  
Bedanta Roy ◽  
Brijesh Sathian ◽  
Shovit Kadkha ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychiatric Illness ◽  
Family Income ◽  
Mental Health Problems ◽  
Psychiatric Patients ◽  
Population Based ◽  
Ethnic Variation ◽  
Cross Sectional ◽  
Economic Class ◽  
Specific Objective

Background: The causes of mental health problems and ethnic variation are poorlyunderstood. The main objective of the study was to find out about psychiatricdiseases which frequently occur in Western Nepal for which hospitalization isrequired. The specific objective was to research about theeconomic condition ofthe psychiatric patients and the prevalence of common psychiatric disorderwitnessed among hospitalized patients who belong to diverse ethnic and culturalgroups in Western Nepal. Materials and Methods: It was a cross sectional studywhich was conducted in between 1st October 2009 and 31th March 2010 between at Manipalteaching hospital, Pokhara, Nepal. Odds ratios and adjusted odds ratio andtheir 95% confidence intervals (95% CI) were calculated. p < 0.05 wasconsidered as statistically significant. Results: Out of 240 cases the commonestcases of psychiatric disorders include Schizophrenia, Schizotypal and DelusionDisorders 36.3%, Mood Disorders 27.9%, Neurotic, stress-related and somatoformdisorders 15.8%. Study based on ethnicity revealed that the majority ofpatients were Dalit [n= 72] followed by Brahmin [n = 66], Chettri [n = 46],Newar [n = 19], Gurung [n = 17], others [n = 13] and Magar and Pun [n = 7].Most of the patients were <40yrs [n=191] unemployed [n=199], monthly familyincome <10000 NPR/month [n= 187], students [n = 102] housewives [n = 74,], job holders [n= 17]. Study showed that Mental and Behavioural disorder due toPsychoactive Substance abuse, Schizophrenia, Schizotypal and Delusion DisordersMood (Affective) Disorders, Neurotic, stress-related and somatoform disorderswere prevalent among unemployed patients [OR 8.170(CI 1.062, 62.853)], [OR3.033(CI 1.334, 6.897)], [OR 0.413(CI 0.199, 0.856)[OR 0.228(CI 0.089,0.583)]as compared to employed patients(p=0.001). Conclusion: Schizophrenia was the commonestpsychiatric disorder among the low socio-economic class of like Dalits. The study showed that culture based differences concerning mental health is furthermediated by poverty, unemployment and dearth of family income which leads tohigh prevalence of psychiatric illness among Nepalese population. Based on thefinding of the study, interventions should target these factors to minimise theload of various psychiatric illness among poor Dalit Nepalese population.DOI: http://dx.doi.org/10.3126/nje.v4i1.10132Nepal Journal of Epidemiology 2014;4 (1): 306-315Keywords:Culture, Ethnicity,Nepal, Psychiatry

scholarly journals Community treatment orders and mental health social work: Issues for policy and practice in the UK and Ireland

2019 ◽  
Vol 64 ◽  
pp. 230-237 ◽  
Author(s):  
Jim Campbell ◽  
Gavin Davidson ◽  
Pearse McCusker ◽  
Hannah Jobling ◽  
Tom Slater
Keyword(s):  
Mental Health ◽  
Social Work ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Policy And Practice ◽  
The Uk

scholarly journals Impact of compulsory community treatment on admission rates

2004 ◽  
Vol 184 (5) ◽  
pp. 432-438 ◽  
Author(s):  
Stephen R. Kisely ◽  
Jianguo Xiao ◽  
Neil J. Preston
Keyword(s):  
Health Service ◽  
Service Use ◽  
Psychiatric Patients ◽  
Community Treatment ◽  
Health Service Use ◽  
Community Treatment Orders ◽  
Stage Design ◽  
Admission Rates ◽  
Compulsory Community Treatment ◽  
Socio Demographic Factors

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.

The ethics of coercion in community mental health care

2016 ◽  
Author(s):  
Tania Gergel ◽  
George Szmukler
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Community Mental Health ◽  
Mental Health Care ◽  
Community Treatment ◽  
Best Interests ◽  
Community Mental Health Care ◽  
Involuntary Treatment ◽  
Community Treatment Orders ◽  
Specific Context

The specific context of community mental health care affects the debate surrounding coercion in psychiatry, not by raising radically new questions but by highlighting the complexity of this debate and some of the associated ethical difficulties. This chapter begins by looking at the varying conventional justifications for involuntary treatment and then considers the different mechanisms through which such ‘coercion’ is enforced within the community—from formal compulsion via community treatment orders (CTOs) through to ‘softer’ pressures, such as ‘persuasion’ or ‘interpersonal leverage’. Some commonly accepted ideas surrounding interventions such as ‘incentives’ and ‘threats’ are challenged. The chapter concludes with some broad suggestions as to a how a reformulated ‘decision-making capability and best interests’ approach may be one way to increase the ethical viability of community coercion.

Coercion in Community Mental Health Care

2016 ◽  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mentally Ill ◽  
Community Care ◽  
Current Knowledge ◽  
Community Services ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Improved Outcome

The use of coercion is one of the defining issues of mental health care and has been intensely controversial since the very earliest attempts to contain and treat the mentally ill. The balance between respecting autonomy and ensuring that those who most need treatment and support are provided with it has never been finer, with the ‘move into the community’ in many high-income countries over the last 50 years and the development of community services. The vast majority of patients worldwide now receive mental health care outside hospital, and this trend is increasing. New models of community care, such as assertive community treatment (ACT), have evolved as a result and there are widespread provisions for compulsory treatment in the community in the form of community treatment orders. These legal mechanisms now exist in over 75 jurisdictions worldwide. Many people using community services feel coerced, but at the same time intensive forms of treatment such as ACT, which arguably add pressure to patients to engage in treatment, have been associated with improved outcome. This volume draws together current knowledge about coercive practices worldwide, both those founded in law and those ‘informal’ processes whose coerciveness remains contested. It does so from a variety of perspectives, drawing on diverse disciplines such as history, law, sociology, anthropology, and medicine and for is explored

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