A systematic review and meta-analysis of predictors and outcomes of community treatment orders in Australia and New Zealand

Abstract

Objectives: Australia and New Zealand have some of the highest rates of compulsory community treatment order use worldwide. There are also concerns that people from culturally and linguistically diverse backgrounds may have higher rates of community treatment orders. We therefore assessed the health service, clinical and psychosocial outcomes of compulsory community treatment and explored if culturally and linguistically diverse, indigenous status or other factors predicted community treatment orders. Methods: We searched the following databases from inception to January 2020: PubMed/Medline, Embase, CINAHL and PsycINFO. We included any study conducted in Australia or New Zealand that compared people on community treatment orders for severe mental illness with controls receiving voluntary psychiatric treatment. Two reviewers independently extracted data, assessing study quality using Joanna Briggs Institute scales. Results: A total of 31 publications from 12 studies met inclusion criteria, of which 24 publications could be included in a meta-analysis. Only one was from New Zealand. People who were male, single and not engaged in work, study or home duties were significantly more likely to be subject to a community treatment order. In addition, those from a culturally and linguistically diverse or migrant background were nearly 40% more likely to be on an order. Indigenous status was not associated with community treatment order use in Australia and there were no New Zealand data. Community treatment orders did not reduce readmission rates or bed-days at 12-month follow-up. There was evidence of increased benefit in the longer-term but only after a minimum of 2 years of use. Finally, people on community treatment orders had a lower mortality rate, possibly related to increased community contacts. Conclusion: People from culturally and linguistically diverse or migrant backgrounds are more likely to be placed on a community treatment order. However, the evidence for effectiveness remains inconclusive and limited to orders of at least 2 years’ duration. The restrictive nature of community treatment orders may not be outweighed by the inconclusive evidence for beneficial outcomes.

Coercion in psychiatric and mental health nursing: A conceptual analysis

“…One example is the implementation of community treatment orders (CTOs), the use of which is increasing in several countries (Kisely et al . 2020). In jurisdictions such as England and New Zealand, nurses are now formally integrated in the CTOs’ enforcement process and may be designated as responsible clinicians (McKenna et al .…”

“…Although coercive practices within the psychiatric asylums of the past (Goffman 1961;Szasz 2009) have been decried and modified since that time (notably due to deinstitutionalization and the civil rights movement), coercion is still present in the psychiatric environment and community care. One example is the implementation of community treatment orders (CTOs), the use of which is increasing in several countries (Kisely et al 2020). In jurisdictions such as England and New Zealand, nurses are now formally integrated in the CTOs' enforcement process and may be designated as responsible clinicians (McKenna et al 2006;Veitch & Oates 2017).…”

Characteristics of people on long-acting injectable antipsychotics in Australia: Data from the 2010 National Survey of High Impact Psychosis

“…With more effective communication, clinicians could help reduce negative feelings towards LAI treatment for those treated under treatment orders. Despite the clinical relevance, the association between LAI use and treatment orders has not been sufficiently explored in Australasia (Kisely et al, 2020). Future research should explore in more detail how community treatment orders may impact on LAI treatment for our patients and clinicians, both in quantitative and qualitative manners.…”

Characteristics of people on community treatment orders in Australia: Data from the 2010 National Survey of High Impact Psychosis

“…The rates of CTO use in Australia are high compared to other parts of the world but show a wide variation by jurisdiction (Light, 2019;Light et al, 2012;O'Donoghue et al, 2016;Rugkasa, 2016). For instance, the proportion of people in contact with state-run mental health services on CTOs ranges from 3.1% in Western Australia to 22.3% in Queensland (Kisely et al, 2020a(Kisely et al, , 2020b. A recent systematic review of CTO use across Australian and New Zealand found that CTO placement was associated with being male, single, a lack of vocational engagement, migrant background, primary diagnosis of non-affective psychosis, comorbid substance use and past contact with the criminal justice system (Kisely et al, 2020b).…”