Community Treatment Order Outcomes in Quebec: A Unique Jurisdiction

Area of Science:

• Psychiatry
• Mental Health Services Research
• Forensic Psychiatry

Background:

• Severe and persistent mental illness (SPMI) poses significant challenges for individuals and healthcare systems.
• Compulsory Community Treatment Orders (CTOs) are legal mechanisms used to manage SPMI patients in the community.
• Unique Canadian jurisdiction allows for long-duration CTOs with strict enforcement.

Purpose of the Study:

• To evaluate the effectiveness of extended duration CTOs for SPMI patients.
• To determine if CTOs reduce hospitalization costs.
• To analyze the impact of CTOs on medication adherence and community tenure.

Main Methods:

• Naturalistic, mirror-image design using patients as their own controls.
• Study included 367 SPMI clinic patients over 5 years.
• Data collected on CTOs, long-acting antipsychotic injections (LAIs), emergency visits, hospitalizations, and legal involvement.
• Statistical analyses included mixed-effect linear regression and survival analysis (Kaplan-Meier, Cox models).

Main Results:

• CTO patients were significantly more severely ill than non-CTO patients.
• Adherence to LAIs increased significantly over time following CTO implementation (P < 0.001).
• Patients under CTO spent significantly more time in the community and had decreased hospitalization durations.

Conclusions:

• Extended duration CTOs enhance LAI adherence and outpatient visits.
• Increased community time and reduced hospitalization suggest potential cost savings.
• The coercive nature of CTOs must be considered alongside their benefits.