Interventions to Reduce Compulsory Psychiatric Admissions

Abstract

The meta-analysis of the RCTs on advance statements showed a statistically significant and clinically relevant 23% reduction in compulsory admissions in adult psychiatric patients, whereas the meta-analyses of the RCTs on community treatment orders, compliance enhancement, and integrated treatment showed no evidence of such a reduction. To date, only 13 RCTs have used compulsory admissions as their primary or secondary outcome measure. This demonstrates the need for more research in this field.

Overview of post-discharge predictors for psychiatric re-hospitalisations: a systematic review of the literature

“…However, these mixed results tend to offer more support for programs adapted to target patient subgroups than for the classic case management model. For compulsory outpatient treatment our review has found mixed evidence, although a recent systematic review shows that CTOs have no impact on compulsory admissions [92]. An encouraging result of our study is represented by the evidence that specific programs or interventions focusing on reducing readmission rates, whatever their focus might be (i.e.…”

“…As a result, relevant papers for the topic of post-discharge factors associated with readmissions but focussing on a particular category of factors may have been missed in the search process. For example, the field of compulsory outpatient treatment is well developed, in the recent years several RCTs and systematic reviews having been conducted on this particular topic [92, 94]. Despite this, only five papers have been identified and included in our review.…”

Variation in compulsory psychiatric inpatient admission in England: a cross-classified, multilevel analysis

“…Both are, and is likely to prove important in developing future interventions to reduce compulsion. 29 And whereas previous interventions to reduce compulsory admission have focused primarily on the individual (patient) level, such as Community Treatment Orders and enhanced care plans, 11 our findings suggestmean that interventions will need to operate at more than one spatial level to be effective.…”

“…Orders and enhanced care plans, 11 our findings suggest that interventions will need to operate at more than one spatial level to be effective.…”

“…9,10 . Attempts to reduce compulsory treatment through advance directives and enhanced crisis care plans have had only modest effects, 11 highlighting the need for further intervention strategies.…”