The association between discontinuation of community treatment orders and outcomes in the 12-months following discharge from residential mental health rehabilitation

Stephen Parker; Urska Arnautovska; Gemma McKeon; Steve Kisely

doi:10.1016/j.ijlp.2020.101664

The association between discontinuation of community treatment orders and outcomes in the 12-months following discharge from residential mental health rehabilitation

Int J Law Psychiatry. 2021 Jan-Feb:74:101664. doi: 10.1016/j.ijlp.2020.101664. Epub 2020 Dec 11.

Authors

Stephen Parker¹, Urska Arnautovska², Gemma McKeon³, Steve Kisely⁴

Affiliations

¹ Staff Specialist - Psychiatry Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, Australia; Faculty of Medicine, University of Queensland, School of Public Health, Herston, Australia. Electronic address: stephen.parker@health.qld.gov.au.
² Senior Research Officer PA Foundation, Princess Alexandra Hospital, Brisbane, Australia.
³ Clinical Neuropsychologist and Clinical Psychologist Child and Youth Mental Health Group, QIMR Berghofer Medical Research Institute, Australia; Psychosis ACU, Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, Australia.
⁴ Faculty of Medicine, University of Queensland, School of Public Health, Herston, Australia.

PMID: 33316696
DOI: 10.1016/j.ijlp.2020.101664

Abstract

To compare the post-discharge outcomes of people admitted to community-based residential mental health rehabilitation facilities subject to a Community Treatment Order (CTO) who do and do not have this order discontinued prior to discharge. People subject to a CTO who were admitted across five Community Care Units (CCUs) in Queensland, Australia between 2005 and 2014 (N = 311), were grouped based on involuntary treatment status at the time of their discharge. Individuals whose status changed to voluntary (n = 63; CTO > VOL) were compared with those whose treatment remained involuntary (n = 248; CTO-CTO) on demographic, clinical and treatment-related characteristics. Group-level and individualised changes were assessed between the year pre-admission and the year post-discharge. The primary outcome measure was change in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes included disability (Life Skills Profile-16), service use, accommodation instability, and involuntary treatment. Logistic regression was completed to examine predictors of CTO discontinuation during CCU care. Potential predictors covered service-, consumer-, and treatment-related characteristics. Compared to the CTO-CTO group, the CTO > VOL group had significantly longer episodes of CCU care, more frequent primary diagnoses of schizophrenia spectrum disorders, and were more likely to be female. Following discharge, CTO > VOL subjects had more frequent reliable and clinically significant improvement in HoNOS scores, as well as more frequently demonstrated reliable improvement in hospital bed use and accommodation instability than the CTO-CTO subjects. CTO discontinuation was predicted by longer duration of CCU care, being a female, and having a smaller number of psychiatry-related bed use prior admission. Our findings suggest that CCU care of sufficient duration may lessen the need for subsequent compulsory treatment in the community.

Keywords: Community mental health; Community treatment order; Recovery-oriented services; Schizophrenia; Severe mental illness.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aftercare
Community Mental Health Services*
Female
Humans
Male
Mental Disorders* / therapy
Patient Discharge
Psychiatric Rehabilitation*
Schizophrenia*