Mortality-Risk With "Capacity" Constraints On Community Treatment Order Utilization.

Area of Science:

• Public Health
• Psychiatry
• Health Services Research

Background:

• Community treatment orders (CTOs) have historically been associated with reduced mortality risk in schizophrenia patients.
• Civil liberties reforms in Victoria, Australia, led to a 15% decrease in CTO assignments for first-time hospitalized schizophrenia patients between 2010 and 2019.
• This reduction in CTO utilization raises questions about its impact on patient mortality risk.

Purpose of the Study:

• To investigate the impact of reduced community treatment order (CTO) utilization on mortality risk among patients diagnosed with schizophrenia.
• To compare mortality risk across different treatment pathways, including CTO, non-CTO hospitalization, and outpatient care for schizophrenia patients.

Main Methods:

• A retrospective cohort study analyzed mortality data from 2010-2019 for 4848 first-time hospitalized patients on CTO, 3988 matched hospitalized patients without CTO, and 1675 never-hospitalized outpatients with schizophrenia.
• Deaths were compared against expected mortality rates using standardized mortality ratios for Victoria.
• Logistic regression controlled for race, demographics, co-occurring physical illnesses, mental health service access, and social disadvantage indicators.

Main Results:

• A significant proportion (78%) of the 777 schizophrenia patient deaths across all groups were premature.
• No significant difference in mortality risk was observed between the two hospitalized groups (CTO vs. non-CTO).
• Schizophrenia outpatients (including treatment refusers) exhibited a 48% higher risk of death compared to hospitalized patients, after accounting for covariates. The prevalence of schizophrenia diagnoses among outpatients increased significantly.

Conclusions:

• Decreased utilization of community treatment orders (CTOs), potentially linked to increased treatment refusal, appears to have elevated mortality risk for schizophrenia patients.
• The balance between civil rights protections and ensuring adequate care for vulnerable individuals with schizophrenia has become blurred.
• This shift necessitates a re-evaluation of community treatment policies to mitigate increased mortality risks.