Benefits following community treatment orders have an inverse relationship with rates of use: meta-analysis and meta-regression
Open accessAbstract
Background: Community treatment order (CTO) use in Australia and New Zealand ranges from less than 40 per 100 000 population in Western Australia and Canterbury to over 100 per 100 000 in Victoria, South Australia and Waitemata. Recent publications on CTO use now permit a meta-regression to investigate whether differences in CTO use by jurisdiction affect either the possible predictors or outcomes of CTOs. Aims: To assess whether factors associated with CTO placement or subsequent outcomes vary by rates of use. Method: A systematic search of PubMed/Medline, Embase, CINAHL, the Cochrane Central Register of Controlled Trials and PsycINFO for any Australian or New Zealand study comparing CTO cases with controls receiving voluntary psychiatric treatment. This study was prospectively registered with PROSPERO (protocol registration number: CRD42022351500). Results: There were 35 articles from 16 studies identified in the search, plus unpublished data from a further study. Of these, 29 publications were included in meta-analyses. Two were from New Zealand. People who were male, single and not engaged in work, study or home duties were significantly more likely to be on CTOs. In addition, those from migrant backgrounds were 47% more likely to be on an order. On meta-regression, cases in jurisdictions with higher CTO rates had higher proportions of females or individuals with diagnoses other than non-affective psychoses. High-use jurisdictions were also less likely to show reductions in readmission rates or bed-days. Conclusions: There are marked differences in the possible predictors and outcomes of CTO placement between high- and low-use jurisdictions in Australia and New Zealand. These findings may have implications elsewhere and indicate that better-targeted CTO placement might improve outcomes.
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Community treatment orders had no effects on court appearances.
“CTOs had no effects on court appearances.”
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 Kisely et al. (2023)
The Results (Secondary outcomes) report that one study found CTOs were not associated with fewer subsequent court appearances than controls after adjustment for several variables. That supports a narrower statement than “no effects”: the paper reports one study’s finding about reductions, not an absence of any effect on court appearances. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOn meta-regression, jurisdictions with high rates of community treatment order use were less likely to show reductions in readmission rates or bed-days than those with lower rates.
“On meta-regression, jurisdictions with high rates of CTO use were less likely to show reductions in readmission rates or bed-days than those with lower rates.”
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 Kisely et al. (2023)
The scope of individual reviews of community treatment orders has been limited, with quantitative reviews largely restricted to health service use and particular countries.
“The scope of individual reviews has also been limited, quantitative reviews largely being restricted to health service use (Barnett et al., 2018) and particular countries (Kisely et al., 2023).”
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 Kisely et al., 2023
There were better outcomes for community treatment orders of > 2 years or from the 5th community treatment order onwards.
“There were better outcomes for CTOs of > 2 years or from the 5th CTO onwards.”
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 Kisely et al. (2023)
Two Australian systematic reviews reported better outcomes in terms of reduced inpatient health service use for community treatment orders of greater than 2 years' duration or from the fifth community treatment order onwards.
“The two Australian SRs (Kisely et al., 2021, 2023) also reported that there were better outcomes in terms of reduced inpatient health service use for CTOs of greater than 2 years’ duration or from the fifth CTO onwards”
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 Kisely et al., 2023
One systematic review from Australia and New Zealand reported an inverse relationship using meta-regression between state-wide rates of community treatment order placement and subsequent inpatient use, such that jurisdictions with low rates of community treatment order use were more likely to show reductions in readmission rates or bed-days than those with higher rates.
“One of the SRs from Australia and New Zealand also reported an inverse relationship using meta-regression between state-wide rates of CTO placement and subsequent inpatient use with the result that jurisdictions with low rates of CTO use were more likely to show reductions in readmission rates or bed-days than those with higher rates”
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 Kisely et al., 2023
There were better outcomes for longer-term community treatment orders, or from the fifth community treatment order onwards, although the meaning of this is unclear.
“There were better outcomes for longer-term CTOs, or from the fifth CTO onwards, although the meaning of this is unclear”
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 Kisely et al., 2023
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- Authors
- Kisely, S., McMahon, L., & Siskind, D.
- Affiliations
- Griffith University (AU)
- The University of Queensland (AU)
- Corresponding author
- Kisely, Steve
- Venue
- BJPsych Open
- Publisher
- Royal College of Psychiatrists
- Published
- 2023-04-14
- Volume
- 9
- Issue
- 3
- Pages
- e68-e68
- ISSN
- 2056-4724 (ISSN-L)
- PMC
- PMC10134313
- OpenAlex
- W4365479195
- Cited by
- 23
- References
- 57
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 5 · 2023: 1
- FWCI
- 1.17
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BJPsych Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Health and Medical Research Council (Emerging Leadership Fellowship: GNT1194635)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- community treatment orders, involuntary psychiatric treatment, readmission rates, bed days, migration background, sex differences, New Zealand
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