Assessing the Outcome of Compulsory Treatment Orders on Management of Psychiatric Patients at 2 McGill University-Associated Hospitals

By Nakhost, Arash; Perry, John Christopher et al. | Canadian Journal of Psychiatry, June 2012 | Go to article overview

Assessing the Outcome of Compulsory Treatment Orders on Management of Psychiatric Patients at 2 McGill University-Associated Hospitals


Nakhost, Arash, Perry, John Christopher, Frank, Daniel, Canadian Journal of Psychiatry


Objective: Some literature suggests that compulsory community treatment orders (CTOs) are effective in reducing hospitalizations in a subgroup of psychiatric patients with histories of repeated hospitalization, allowing them to be treated in the community under less restrictive measures. However, studies have yielded contradictory findings, in part because of methodological differences. Our study examines the effectiveness of CTOs in reducing hospitalizations and increasing community tenure of such patients.

Method: The sample included all psychiatric patients who had been given a CTO during a 9-year period at 2 of McGill University's hospitals. This is a naturalistic, observational, retrospective, before-and-after study where patients acted as their own control subjects. We examined variables, including the number, duration, and time to psychiatric admissions, comparing 4 time periods: early, pre-index, index (when the first CTO was in force), and post-index periods. The total study duration per subject encompasses the longest period of observation within existing studies in Canada.

Results: Psychiatric patients with histories of frequent readmissions demonstrated a significant reduction in their number of hospitalizations as well as an increase in the median time to re-hospitalization, during the period when they were treated under a CTO. This effect of CTO was sustained even after the CTO had expired.

Conclusions: Our study suggests that CTOs are effective in assisting psychiatric patients with histories of repeated hospitalizations to live and be treated in the community, diminishing the occurrence of frequent hospitalization.

Objective : Une certaine littérature suggère que les ordonnances de traitement en milieu communautaire (OTMC) sont efficaces pour réduire les hospitalisations dans un sous-groupe de patients psychiatriques ayant des antécédents d'hospitalisations répétées, ce qui leur permet d'être traités dans la communauté selon des mesures moins restrictives. Cependant, des études ont livré des résultats contradictoires, en partie à cause des différences méthodologiques. Notre étude examine l'efficacité des OTMC pour réduire les hospitalisations et accroître la période d'affectation communautaire de ces patients.

Méthode : L'échantillon incluait tous les patients psychiatriques ayant reçu une OTMC durant une période de 9 ans à 2 hôpitaux de l'Université McGill. Il s'agit d'une étude avant/après, naturaliste, d'observation, et rétrospective où les patients agissaient comme leurs propres sujets témoins. Nous avons examiné les variables, notamment le nombre, la durée, et le délai des hospitalisations psychiatriques, en comparant 4 périodes : précoce, pré-indice, indice (entrée en vigueur de la première OTMC), et post-indice. La durée totale de l'étude par sujet englobe la période d'observation la plus longue des études existantes au Canada.

Résultats : Les patients psychiatriques ayant des antécédents de fréquentes réhospitalisations ont démontré une réduction significative de leur nombre d'hospitalisations et un accroissement du délai entre les hospitalisations durant la période où ils ont été traités en vertu d'une OTMC. Cet effet de l'OTMC durait même après l'expiration de l'OTMC.

Conclusions : Notre étude suggère que les OTMC sont efficaces pour aider les patients psychiatriques ayant des antécédents d'hospitalisations répétées à vivre et à être traités dans la communauté, diminuant la réalité des hospitalisations fréquentes.

Key Words: community compulsory treatment orders, reduction in hospitalization, outcomes

Received August 2011 , revised, and accepted January 2012.

The preliminary findings from this paper were presented at the Institute on Psychiatric Services meeting in Boston, Massachusetts, October 14-17,2010.

Abbreviations

ACT assertive community treatment

CTO community treatment order

ICM intensive community treatment

JGH Jewish General Hospital

RCT randomized controlled trial

SMH St Mary's Hospital

TAQ Tribunal Adminstratif du Quebec

Some psychiatric patients require repeat hospitalizations owing to the risk of danger that they pose to themselves or the public at large. …

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