Effectiveness of community treatment orders for treatment of schizophrenia with oral or depot antipsychotic medication: changes in problem behaviours and social functioning

Objective: Involuntary outpatient commitment (IOC) has been in use in various countries for a number of years and has recently been implemented (in the form of supervised community treatment) in England and Wales. Several studies indicate that IOC reduces relapse and readmission rates and decreases length of stay on inpatient units in patients diagnosed with schizophrenia. The aim of the present study was to examine whether the use of IOC in the Australian context, in the form of community treatment orders (CTOs), may be associated with a reduction in problem behaviours and improved social functioning. Method: A naturalistic retrospective mirror image study of case notes, with each case serving as its own control, was used. Behavioural and social outcomes were examined: episodes of aggression and suicidal and self-harming behaviour, episodes of homelessness, frequency of contact with family members and overall quality of relationship between family and patient, and employment status. Results: Ninety-four sets of case notes were identified as meeting the criteria for inclusion. The number of episodes of aggression was found to be halved from the year before the CTO to the subsequent year (p<0.0001). Significant reductions in the number of episodes of homelessness were experienced by patients (p<0.05) when the pre-CTO year was compared with the CTO year. Conclusion: A CTO may contribute to improved outcomes related to patient quality of life. This may be seen to mitigate concerns about infringement of civil rights.