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Impact of compulsory community treatment on admission rates: Survival analysis using linked mental health and offender databases

  • Stephen R. Kisely (a1), Jianguo Xiao (a2) and Neil J. Preston (a3)
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 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.

Conclusions

Community treatment orders alone do not reduce admissions.

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Copyright
Corresponding author
Professor Stephen Kisely, Department of Psychiatry, Dalhousie University, Abbie J. Lane Memorial Building, 5909 Veteran's Memorial Lane, Suite 9211, Halifax, Nova Scotia B3H 2E2, Canada. Tel: +1 902 473 7356; fax: + 1 902 473 4887; e-mail: Stephen.Kisely@cdha.nshealth.ca
Footnotes
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Declaration of interest

None. Funding detailed in Acknowledgement.

Footnotes
References
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Impact of compulsory community treatment on admission rates: Survival analysis using linked mental health and offender databases

  • Stephen R. Kisely (a1), Jianguo Xiao (a2) and Neil J. Preston (a3)
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