Community treatment orders increase community care and delay readmission while in force: Results from a large population-based study.

OBJECTIVE: There is debate about the effectiveness of community treatment orders in the management of people with a severe mental illness. While some case-control studies suggest community treatment orders reduce hospital readmissions, three randomised controlled trials find no effects. These randomised controlled trials measure outcomes over a longer period than the community treatment order duration and assess the combined effectiveness of community treatment orders both during and after the intervention. This study examines the effectiveness of community treatment orders in a large population-based sample, restricting observation to the period under a community treatment order. METHODS: All persons ( n = 5548) receiving a community treatment order in New South Wales, Australia, over the period 2004-2009 were identified. Controls were matched using a propensity score based on demographic, clinical and prior care variables. A baseline period equal to each case's duration of treatment was constructed. Treatment effects were compared using zero-inflated negative binomial regression, adjusting for demographics, clinical characteristics and pre-community treatment order care. RESULTS: Compared to matched controls, people on community treatment orders were less likely to be readmitted (odds ratio = 0.90, 95% confidence interval = [0.84, 0.97]) and had a significantly longer time to their first readmission (incidence rate ratio = 1.47, 95% confidence interval = [1.36, 1.58]), fewer hospital admissions (incidence rate ratio = 0.90, 95% confidence interval = [0.84, 0.96]) and more days of community care (incidence rate ratio = 1.55, 95% confidence interval = [1.51, 1.59]). Increased community care and delayed first admission were found for all durations of community treatment order care. Reduced odds of readmission were limited to people with 6 months or less of community treatment order care, and reduced number of admissions and days in hospital to people with prolonged (>24 months) community treatment order care. CONCLUSION: In this large population-based study, community treatment orders increase community care and delay rehospitalisation while they are in operation. Some negative findings in this field may reflect the use of observation periods longer than the period of active intervention.

Behavioural improvements and emotional gains for students attending an Australian School for Specific Purposes.

Outcomes of students with behavioural and emotional difficulties attending a specialised educational programme, delivered in a tertiary education and health facility, were evaluated and compared with Australian normative data. A total of 45 students (5-10 years old) attending the school in Sydney, New South Wales, were identified. At enrolment, parent ratings on the Strengths and Difficulties Questionnaire (SDQ) significantly deviated from Australian normative data on all scales for males and on the overall score, conduct and hyperactivity scales for females. Clinically significant levels of hyperactivity, peer problems and conduct symptoms were identified. After an average attendance at the school of 8.82 months, ratings on the Children's Global Assessment Scale (CGAS) indicated improved overall functioning, alongside specific improvements on SDQ rated emotion, conduct and social symptoms, and in Health of the Nation Outcomes Scales Child and Adolescent (HoNOSCA) rated social impairment and parents' reported need for information about their child's condition. Male students' emotional symptoms no longer differed from those of typical Australian students. The findings provide initial evidence for the effectiveness of a multimodal, flexible and targeted school programme in remediating key student mental health symptoms. It is suggested that major concepts from attachment theory and explicitly taught behavioural skills are key elements of this unique programme that contribute to its apparent effectiveness.