Assessing the outcome of compulsory psychiatric treatment in the community: epidemiological study in Western Australia

• Published in: BMJ Vol. 324; no. 7348; pp. 1244 - 1246
• Main Authors: Preston, Neil J, Kisely, Steve, Xiao, Jianguo
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 25.05.2002; British Medical Association; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ
• Edition: International edition
• Subjects: Ambulatory care utilization; Ambulatory medical care; Biological and medical sciences; Commitment of Mentally Ill; Communities; Community; Community mental health services; Community Mental Health Services - legislation & jurisprudence; Community Mental Health Services - statistics & numerical data; Community psychiatric services; Community service programs; Control Groups; Epidemiology; Ethnicity; Female; Health services; Hospital admissions; Hospital beds; Hospitalization - statistics & numerical data; Hospitals; Humans; Information systems; Length of Stay - statistics & numerical data; Male; Medical sciences; Mental Disorders - epidemiology; Mental Disorders - therapy; Mental health; Mental health care; Mental health outcomes; Mental Health Services - statistics & numerical data; Miscellaneous; Multivariate Analysis; Patient Acceptance of Health Care - statistics & numerical data; Psychiatric hospitals; Psychiatric services; Psychology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Regression analysis; Review boards; Studies; Treatment Outcome; Treatments; Tropical medicine; Utilization; Western Australia - epidemiology; Australia; Western Australia; Oceania; New Zealand; United Kingdom > UK; United States > US; Western Australia Australia; Australasia; New South Wales Australia; Human; Evaluation; Prognosis; Treatment; Health economy; Mental disorder; Community health; Cost analysis; Epidemiology; Public health; Empirical Approach
• ISSN: 0959-8138; 0959-8146; 1756-1833; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.324.7348.1244

Abstract Objective: To examine whether community treatment orders for psychiatric patients reduce subsequent use of health services in comparison with control patients not placed on an order. Design: Epidemiological study with a before and after, two stage design of matching and multivariate analysis, controlling for sociodemographic variables, clinical features, and psychiatric history. Setting: All community based and inpatient psychiatric services in Western Australia, covering a population of 1.7 million people. Participants: 228 subjects placed on a community treatment order, matched with an equal number of controls to give a total of 456 patients. Main outcome measures: Inpatient admissions, bed days, and outpatient contacts one year after subjects were placed on a community treatment order or the index date of matched controls. Results: Both subjects and their matched controls had reduced inpatient admissions and bed days in hospital. Subjects had significantly more outpatient contacts. Multivariate analysis indicated that being placed on a community treatment order was associated with increased outpatient contacts in the subsequent year compared with the control group. Otherwise, orders did not affect subsequent use of health services. Other factors associated with increased use of health services were age and inpatient admissions, bed days, and outpatient contacts before the order or index date. No covariates were shown to be associated with changes in within pair differences in inpatient admissions or bed days. Conclusions: The introduction of compulsory treatment in the community does not lead to reduced use of health services. What is already known on this topic Various forms of compulsory treatment in the community have been suggested as being effective in reducing use of services by patients with mental health disorders Studies have often lacked epidemiological sampling frames and control for possible confounding factors What this study adds Patients placed on community treatment orders and those not on such orders had reduced hospital admissions and bed days one year later Placement of an order did not predict subsequent use of services Community treatment orders may not be an effective alternative to assertive community treatment programmes