PMID- 31818137
OWN - NLM
STAT- MEDLINE
DCOM- 20210818
LR  - 20210818
IS  - 1497-0015 (Electronic)
IS  - 0706-7437 (Print)
IS  - 0706-7437 (Linking)
VI  - 65
IP  - 7
DP  - 2020 Jul
TI  - Community Treatment Order Outcomes in Quebec: A Unique Jurisdiction.
PG  - 484-491
LID - 10.1177/0706743719892718 [doi]
AB  - OBJECTIVE: We study compulsory community treatment orders (CTOs) for patients 
      with severe and persistent mental illness (SPMI). Focusing on a unique 
      jurisdiction in Canada that allows for long duration CTOs with strict enforcement 
      procedures, our objectives are to determine whether extended duration CTOs are 
      effective and to determine whether associated hospitalization costs are reduced. 
      METHOD: A mirror image, naturalistic design was employed using patients as their 
      own controls to enhance external validity. No inclusive or exclusive criteria 
      were employed for the 367 SPMI clinic patients who were studied over a 5-year 
      period. Detailed documentation of the dates of all CTOs, long-acting 
      antipsychotic injections (LAIs), emergency visits, hospitalizations, duration of 
      hospitalizations, crimes and/or police involvement were collected. To study the 
      relation between CTO and injection adherence, we use a mixed-effect linear 
      regression model. To study the effect of injection adherence and hospitalization, 
      we use survival analysis via Kaplan-Meier and Cox survival models. RESULTS: CTO 
      and non-CTO patients did not differ with respect to demographics, but CTO 
      patients were significantly more severely ill. Following a CTO, adherence to LAIs 
      increased over time (P < 0.001). The average time the patients spent in the 
      community, that is, outside the hospital, was significantly longer under a CTO, 
      and the duration of hospitalizations was decreased. CONCLUSIONS: LAI adherence 
      and outpatient office visits were enhanced by extended duration CTOs, as was time 
      out of the hospital. The shorter duration of hospital stays implies cost savings. 
      These must be weighed against their undesirable coercive nature.
FAU - Frank, Daniel
AU  - Frank D
AUID- ORCID: 0000-0001-9469-6624
AD  - Jewish General Hospital, Montreal, Quebec, Canada.
AD  - McGill University, Montreal, Quebec, Canada.
FAU - Fan, E
AU  - Fan E
AD  - McGill University, Montreal, Quebec, Canada.
FAU - Georghiou, Angelos
AU  - Georghiou A
AD  - McGill University, Montreal, Quebec, Canada.
FAU - Verter, Vedat
AU  - Verter V
AD  - Michigan State University, East Lansing, MI, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20191209
PL  - United States
TA  - Can J Psychiatry
JT  - Canadian journal of psychiatry. Revue canadienne de psychiatrie
JID - 7904187
SB  - IM
MH  - *Community Mental Health Services
MH  - Humans
MH  - *Involuntary Treatment
MH  - *Mental Disorders/therapy
MH  - Quebec
MH  - Treatment Outcome
PMC - PMC7298585
OTO - NOTNLM
OT  - community treatment orders
OT  - complex mental health interventions
OT  - naturalistic design
OT  - recidivism
OT  - schizophrenia
OT  - severe and persistent mental illness
COIS- Declaration of Conflicting Interests: The author(s) declared no potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article.
EDAT- 2019/12/11 06:00
MHDA- 2021/08/19 06:00
PMCR- 2021/01/01
CRDT- 2019/12/11 06:00
PHST- 2019/12/11 06:00 [pubmed]
PHST- 2021/08/19 06:00 [medline]
PHST- 2019/12/11 06:00 [entrez]
PHST- 2021/01/01 00:00 [pmc-release]
AID - 10.1177_0706743719892718 [pii]
AID - 10.1177/0706743719892718 [doi]
PST - ppublish
SO  - Can J Psychiatry. 2020 Jul;65(7):484-491. doi: 10.1177/0706743719892718. Epub 
      2019 Dec 9.