Assessing the outcome of compulsory psychiatric treatment in the community: epidemiological study in Western Australia

OBJECTIVE: To examine whether community treatment orders for psychiatric patients reduce subsequent use of health services in comparison with control patients not placed on an order. DESIGN: Epidemiological study with a before and after, two stage design of matching and multivariate analysis, controlling for sociodemographic variables, clinical features, and psychiatric history. SETTING: All community based and inpatient psychiatric services in Western Australia, covering a population of 1.7 million people. PARTICIPANTS: 228 subjects placed on a community treatment order, matched with an equal number of controls to give a total of 456 patients. MAIN OUTCOME MEASURES: Inpatient admissions, bed days, and outpatient contacts one year after subjects were placed on a community treatment order or the index date of matched controls. RESULTS: Both subjects and their matched controls had reduced inpatient admissions and bed days in hospital. Subjects had significantly more outpatient contacts. Multivariate analysis indicated that being placed on a community treatment order was associated with increased outpatient contacts in the subsequent year compared with the control group. Otherwise, orders did not affect subsequent use of health services. Other factors associated with increased use of health services were age and inpatient admissions, bed days, and outpatient contacts before the order or index date. No covariates were shown to be associated with changes in within pair differences in inpatient admissions or bed days. CONCLUSIONS: The introduction of compulsory treatment in the community does not lead to reduced use of health services.