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  • Title: Impact of compulsory community treatment on admission rates: survival analysis using linked mental health and offender databases.
    Author: Kisely SR, Xiao J, Preston NJ.
    Journal: Br J Psychiatry; 2004 May; 184():432-8. PubMed ID: 15123508.
    Abstract:
    BACKGROUND: There is controversy as to whether compulsory community treatment for psychiatric patients reduces hospital admission rates. AIMS: To 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. METHOD: Survival 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. RESULTS: We matched 265 CTO cases with 265 matched controls and 224 consecutive controls (total n=754). The CTO group had a significantly higher readmission rate: 72% v. 65% and 59% for the matched and consecutive controls (log-rank chi(2)=4.7, P=0.03). CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were associated with increased admission rates. CONCLUSIONS: Community treatment orders alone do not reduce admissions.
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