Need For Treatment, A Less Restrictive Alternative To Hospitalization, And Treatment Provision: The Utility Of Community Treatment Orders


 
 
 Provision of involuntary care is an abridgement of civil rights and a source of controversy. Its circumstances require continued monitoring. This study asks four questions: Whether, in an era focused on allowing patients with capacity to refuse community-treatment-order (CTO)-assignment, CTO use decreased. And whether CTOs fulfilled three statute mandates: Were CTO-assigned patients in greater need-of-treatment than other psychiatric-inpatients? Was CTO-assignment a less-restrictive-alternative to psychiatric-hospitalization? and Did CTO-assignment provide needed-treatment at internationally- recommended levels with consequences for patient-outcomes?
 
 
 
 All 214,388 Victoria, Australia mental health admissions between 2000- 2017 were reviewed. Two cohort-samples were drawn and followed through 2019—i.e. all 7,826 hospitalized-patients first placed on CTOs from 2010-2017 and 13,896 hospitalized-patients without CTO-placement. Logistic Regression was used to specify determinants of CTO-assignment from the psychiatric inpatient-population. OLS Regression with propensity score control to evaluate study questions.
 
 
 
 In the 2010-17-decade, initial CTO-assignments decreased 3.5%, and initial hospitalizations increased 5.9% compared to the 2000-09-period. At hospital admission and discharge, based on Health of the Nations Score ratings, the CTO-cohort’s need-for-treatment exceeded that of non-CTO-patients. CTO-patients had 3.75 fewer days in average inpatient episode duration than other inpatients, when adjusted for CTO-assignment determinants, the ratio of patients to community case managers, and patient housing status. CTO-patients needing rehospitalization spent 112.68 more days in the community than re-hospitalized non-CTO-patients. Patient to case manager ratios falling above recommended levels and the patient marginal housing-status contributed to longer hospital stays and reduced community tenure.
 
 
 
 Victoria relied less on CTOs as an LRA, consequently, experiencing increased initial hospitalizations. CTO-patients were in greater need-of-treatment than non-CTO-patients, yet, with required oversite had shorter hospitalizations and more time out of hospital prior to rehospitalization than the less severely ill non-CTO-group. Patient LRA outcomes were adversely affected by higher than recommended community patient to case-manager ratios limiting needed treatment provision to hospital.
