Steven P Segal1, Stephania L Hayes1, Lachlan Rimes1. 1. Dr. Segal and Ms. Hayes are with the School of Social Welfare, University of California, Berkeley. Dr. Segal is also with the Department of Social Work, Melbourne School of Health Sciences, Melbourne, Victoria, Australia. Mr. Rimes is with the Victoria Department of Health and Human Services, Melbourne.
Abstract
OBJECTIVE: This study assessed the contribution of a form of outpatient commitment-community treatment orders (CTOs)-to mortality risk and quality of life of patients with severe mental illness. METHODS: Data (2000--2012) were obtained from the Australian National Death Index, Victoria Department of Health, Victoria police records, and National Outcomes and CaseMix Collection quality-of-life records for patients in the Victorian Psychiatric Case Register/RAPID with a history of psychiatric hospitalization: CTO cohort, N=11,424; non-CTO cohort, N=16,161. The contribution of CTOs to mortality risk associated with CTO facilitation of access to general medical care and prevention of criminal involvement was assessed with logistic regression models. Cohort differences in quality of life were also examined. RESULTS: A total of 2,727 patients (10%) in the overall sample died, and the sample had a higher mortality risk than the general population. Probability of death by any cause was 9% lower in the CTO cohort than in the non-CTO cohort. Facilitation of access to medical care accounted for a 20% reduction in risk of non-injury-related deaths in the CTO cohort, compared with the non-CTO cohort. Risk of death by self-harm was 32% higher, compared with the non-CTO cohort. CTO placement appeared to lead to a gain of 3.8 years of life among men and 2.4 years among women, compared with the non-CTO cohort. Quality-of-life scores were modestly less favorable for the non-CTO cohort. CONCLUSIONS: CTO placement was associated with lower mortality risk via facilitated access to medical care and with modest enhancement of quality of life.
OBJECTIVE: This study assessed the contribution of a form of outpatient commitment-community treatment orders (CTOs)-to mortality risk and quality of life of patients with severe mental illness. METHODS: Data (2000--2012) were obtained from the Australian National Death Index, Victoria Department of Health, Victoria police records, and National Outcomes and CaseMix Collection quality-of-life records for patients in the Victorian Psychiatric Case Register/RAPID with a history of psychiatric hospitalization: CTO cohort, N=11,424; non-CTO cohort, N=16,161. The contribution of CTOs to mortality risk associated with CTO facilitation of access to general medical care and prevention of criminal involvement was assessed with logistic regression models. Cohort differences in quality of life were also examined. RESULTS: A total of 2,727 patients (10%) in the overall sample died, and the sample had a higher mortality risk than the general population. Probability of death by any cause was 9% lower in the CTO cohort than in the non-CTO cohort. Facilitation of access to medical care accounted for a 20% reduction in risk of non-injury-related deaths in the CTO cohort, compared with the non-CTO cohort. Risk of death by self-harm was 32% higher, compared with the non-CTO cohort. CTO placement appeared to lead to a gain of 3.8 years of life among men and 2.4 years among women, compared with the non-CTO cohort. Quality-of-life scores were modestly less favorable for the non-CTO cohort. CONCLUSIONS:CTO placement was associated with lower mortality risk via facilitated access to medical care and with modest enhancement of quality of life.
Entities:
Keywords:
Medical morbidity and mortality, Outpatient commitment, Deinstitutionalization, Involuntary commitment, Law & psychiatry
Authors: Virginia Aldigé Hiday; Marvin S Swartz; Jeffrey W Swanson; Randy Borum; H Ryan Wagner Journal: Am J Psychiatry Date: 2002-08 Impact factor: 18.112