The effect of community treatment orders on outcome as assessed by the Health of the Nation Outcome Scales

Kisely, Steve; Xiao, Jianguo; Crowe, Elizabeth; Paydar, Anita; Jian, Le

doi:10.1016/j.psychres.2013.12.036

Cited by 15 publications

(17 citation statements)

References 27 publications

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“…All the factors mentioned above, and probably others not recognized here, may partly explain why OC studies so far show no effect, or are inconclusive. Given the current situation, we concur with other authors advocating the need for more and better designed studies on OC [2, 10, 22], based on more comprehensive data, more relevant outcome measures and longer follow-up periods.…”

Section: Discussionsupporting

confidence: 84%

Patients on outpatient commitment orders in Northern Norway

2017

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BackgroundIn recent years, an increasing number of countries have introduced outpatient commitment orders (OC), which imply that patients can be subject to compulsory follow-up and treatment while living in the community. However, few studies on how OC is practised have been published.MethodRetrospective case register study based on medical files of all patients receiving an OC order in 2008–2012. We used a pre/post design, recording the use of inpatient services three years before and three years after for those patients who received their first ever OC order in 2008 and 2009.ResultsA total of 345 OC orders applying to 286 persons were identified in the study period 2008–2012. Incidence and prevalence rates were relatively stable, but decreased during the last years of the study period. For all the 54 patients receiving their first ever OC order in 2008 and 2009, need for treatment was the reason for imposing OC, and all received psychotropic medication. The number of inpatient admissions and inpatient days was greater, while the number of days for each admission was lower three years after the OC order than three years before. The first ever OC lasted under a year for 76% of the patients. Receiving depot medication and follow-up by psychiatrists predicted longer OC durations than such treatment and care by psychologists. Only nine patients were not hospitalized during the three-year follow-up after the first ever OC order.ConclusionPatients on first ever OC orders in Northern Norway used inpatient services more after OC orders than before. Further studies are needed to explore whether increased use of inpatient services by OC patients is beneficial or a failure of OC.

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Section: Discussionsupporting

confidence: 84%

Patients on outpatient commitment orders in Northern Norway

2017

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“…This adjusted for the possibility that controls from the same jurisdiction may differ in ways for which it was not possible to match or adjust (Kisely et al, 2005). CTOs also had no effect on psychiatric symptomatology as measured by the Health of the Nation Outcome Scales (HoNOS) compared to matched controls at 6-and 12-month follow-up (Kisely et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…Further RCTs of CTOs are unlikely, given ethical challenges inherent in randomising those who may lack insight, and who may be dangerous to themselves or others, to legal restriction versus truly voluntary care (Weich et al, 2018). As a result, there has been renewed interest in populationbased observational studies such as before-and-after or matched cohort designs, several of which were undertaken in Western Australia, Victoria and New South Wales (Kisely et al, 2004(Kisely et al, , 2005(Kisely et al, , 2013(Kisely et al, , 2014Preston et al, 2002;Segal and Burgess, 2006;Segal et al, 2017;Vaughan et al, 2000;Harris et al, 2019). These studies give conflicting or equivocal evidence for their efficacy, depending on the exact methodology.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of compulsory community treatment and use in minority ethnic populations: A statewide cohort study

Kisely

Moss

Boyd

et al. 2019

Aust N Z J Psychiatry

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Background: There is conflicting and equivocal evidence for the efficacy of compulsory community treatment within Australia and overseas, but no study from Queensland. In addition, although people from Indigenous or culturally and linguistically diverse backgrounds are over-represented in compulsory admissions to hospital, little is known about whether this also applies to compulsory community treatment. Aims: We initially investigated whether people from Indigenous or culturally and linguistically diverse backgrounds in terms of country of birth, or preferred language, were more likely to be on compulsory community treatment using statewide databases from Queensland. We then assessed the impact of compulsory community treatment on health service use over the following 12 months. Compulsory community treatment included both community treatment orders and forensic orders. Methods: Cases and controls from administrative health data were matched on age, sex, diagnosis and time of hospital discharge (the index date). Multivariate analyses were used to examine potential predictors of compulsory community treatment, as well as impact on bed-days, time to readmission or contacts with public mental health services in the subsequent year. Results: We identified 7432 cases and controls from January 2013 to February 2017 (total n = 14,864). Compulsory community treatment was more likely in Indigenous Queenslanders (adjusted odds ratio = 1.45; 95% confidence interval = [1.28, 1.65]) subjects coming from a culturally and linguistically diverse background (adjusted odds ratio = 1.54; 95% confidence interval = [1.37, 1.72]), or those who had a preferred language other than English (adjusted odds ratio = 1.66; 95% confidence interval = [1.30, 2.11]). While community contacts were significantly greater in patients on compulsory community treatment, there was no difference in bed-days while time to readmission was shorter. Restricting the analyses to just community treatment orders did not alter these results. Conclusion: In common with other coercive treatments, Indigenous Australians and people from culturally and linguistically diverse backgrounds are more likely to be placed on compulsory community treatment. The evidence for effectiveness remains inconclusive.

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“…13 A number of non-randomised studies have provided negative and conflicting results and thus have not provided sufficient evidence to support CTOs. 3,14,15 Three independent RCTs and a meta-analysis of their data have shown no benefit of the CTO on the number of hospital admissions and other relevant outcomes. 16–20 Patients on a CTO have shown even less adherence to depot injections than those not on a CTO.…”

Section: The Arguments On the Con-sidementioning

confidence: 99%

Little evidence for community treatment orders – a battle fought with heavy weapons

2016

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This editorial discusses the pros and cons of community treatment orders (CTOs) from the perspective of community general adult psychiatry. There is little scientific evidence supporting the application of CTOs. Preconditions of a CTO to work are likely to be met by few patients. The time for the application of a CTO may be better spent for patient-centred care until there is sufficient new and robust evidence that identifies the patients that might profit.

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The effect of community treatment orders on outcome as assessed by the Health of the Nation Outcome Scales

Cited by 15 publications

References 27 publications

Patients on outpatient commitment orders in Northern Norway

Patients on outpatient commitment orders in Northern Norway

Efficacy of compulsory community treatment and use in minority ethnic populations: A statewide cohort study

Little evidence for community treatment orders – a battle fought with heavy weapons

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