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Bardell-Williams M, Eaton S, Downey L, Bowtell M, Thien K, Ratheesh A, Killackey E, McGorry P, O'Donoghue B. Rates, determinants and outcomes associated with the use of community treatment orders in young people experiencing first episode psychosis. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 62:85-89. [PMID: 30616858 DOI: 10.1016/j.ijlp.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/31/2018] [Accepted: 11/24/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Community treatment orders (CTOs) are a controversial form of involuntary treatment for individuals affected by mental health disorders and yet little is known about the use of CTOs in first presentations. Therefore, this study aimed to determine the rates, determinants and outcomes associated with the use of CTOs in young people with a first episode of psychosis (FEP). METHODS This epidemiological cohort study included all individuals aged 15-24 who presented with a FEP to the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne between 01.01.2011 and 31.12.13. RESULTS A total of 544 young people presented with a FEP during the study period and of these, 93 (17.3%) were subject to a CTO during their episode of care. A total of 69.7% of CTOs were commenced after the first three months of treatment and the median duration of CTOs was 168.5 days. Males, a diagnosis of a schizophrenia spectrum disorder and a concurrent substance abuse disorder were associated with the use of CTOs. Additionally, young people with more severe positive psychotic symptoms were more likely to be subject to a CTO. At the time of discharge, only 38.7% of those subject to a CTO were in education or employment compared to 65.4% of those who had not been subject to a CTO. CONCLUSIONS The majority of CTOs are commenced after at least three months of treatment, however the optimal timing of CTO implementation needs to be determined. The poor functioning of young people on a CTO should be the focus of future interventional studies.
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Affiliation(s)
- Melissa Bardell-Williams
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Scott Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Linglee Downey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Meghan Bowtell
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Kristen Thien
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Orygen Youth Health, 35 Poplar Rd, Parkville, Melbourne, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Orygen Youth Health, 35 Poplar Rd, Parkville, Melbourne, Australia.
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