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Cited by 21Healthcare Decision-Making and RestraintsPsychiatric care and mental health servicesHistorical Psychiatry and Medical Practices

Compulsory Community Treatment Orders in New Zealand and the provision of care: An examination of national databases and predictors of outcome

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Beaglehole, Ben, Newton-Howes, Giles, Frampton, Chris·2021·The Lancet Regional Health - Western Pacific
DOI 10.1016/j.lanwpc.2021.100275PMC PMC8488594
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Abstract

BACKGROUND: Compulsory Community Treatment Orders (CTOs) are contentious because they impose severe restrictions on individuals in community settings. The existing evidence for CTOs is constrained by ethical and methodological limitations and may not support usual clinical practise. This study examines the effectiveness of CTOs using routine data in the New Zealand context. METHODS: Ministry of Health, New Zealand databases provided demographic, service use, and medication dispensing data for all individuals placed on a CTO between 2009 and 2018. We examined the effectiveness of CTOs through a comparison of psychiatric endpoints identified as useful in the literature according to CTO status. Further analyses examined the moderating influences of age, sex, ethnicity, and diagnosis on outcome. FINDINGS: 14,726 patients were placed under a CTO over the 10 year period between 1 January 2009 and 31 December 2018. Patients on CTOs experienced a reduced frequency of admissions (rate ratio of 0∙94, 95% CI 0.93-0.95, p<0.01) reduced admission days (rate ratio 0∙97, 95% CI 0.97-0.98 p<0∙01), increased frequency of psychiatric community contacts (rate ratio 3∙03, 95% CI 3.02-3.03 p<0.01), and increased dispensing of psychiatric medication (rate ratio 2.27, 95% CI 2.27-2.28, p<0.01). When sub-group analyses were undertaken, the association between treatment under a CTO and reduced admission frequency was only present for those with Psychotic Disorders. INTERPRETATION: CTOs in New Zealand are associated with increased community care, and increased dispensing of psychiatric medication. Patients with Psychotic Disorders also experienced reduced frequency and length of admissions whilst under a CTO. FUNDING: No specific funding was received for this study.

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  • These results are consistent with a recent New Zealand-wide epidemiological study where reductions in health service use following community treatment orders were limited to people with schizophrenia.

    “These results are consistent with a recent New Zealand-wide epidemiological study where reductions in health service use following CTOs were limited to people with schizophrenia”

    From The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses (2024) · cites this paper as Beaglehole et al., 2021

    The Discussion reports that reductions in admission frequency and length were limited to people with a Psychotic Disorder. The claim narrows that group to people with schizophrenia and broadens the outcome to health service use generally, although the paper reports increased community care under CTOs. (LLM, conf=0.88)

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Authors
Beaglehole, B., Newton-Howes, G., & Frampton, C.
Affiliations
University of Otago (NZ)
Corresponding author
Beaglehole, Ben
ORCID
Venue
The Lancet Regional Health - Western Pacific
Publisher
Elsevier BV
Published
2021-12
Volume
17
Pages
100275
ISSN
2666-6065 (ISSN-L)
DOI
10.1016/j.lanwpc.2021.100275
PMC
PMC8488594
OpenAlex
W3202020664
Cited by
21
References
6
Citations by year
2026: 5 · 2025: 4 · 2024: 6 · 2023: 5 · 2022: 1
FWCI
2.05
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Regional Health - Western Pacific (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
Keywords
involuntary psychiatric treatment, psychiatric hospital admissions, community-based psychiatric care, psychosis, treatment outcomes, routine health data

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