Cochrane · systematic review · CD004408
Compulsory community and involuntary outpatient treatment for people with severe mental disorders
Kisely, SR, Campbell, LA, O'Reilly, R · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
19
current version
GRADE rated
19
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 7 · 36.8%Moderate 12 · 63.2%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyCOURT ORDERED OUTPATIENT COMMITMENT compared with ENTIRELY VOLUNTARY CARE for people with severe mental disorders
Population: people with severe mental disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Health service outcomes: 1. Readmission to hospital by 11 to 12 months COURT ORDERED OUTPATIENT COMMITMENT vs ENTIRELY VOLUNTARY CARE | RR 0.98 [0.79, 1.21] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Health service outcomes: 4. Compliance with medication by 11 to 12 months COURT ORDERED OUTPATIENT COMMITMENT vs ENTIRELY VOLUNTARY CARE | RR 0.99 [0.83, 1.19] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Participant level outcomes: 2. Social functioning: trouble with police by 11 to 12 months, at least 1 arrest COURT ORDERED OUTPATIENT COMMITMENT vs ENTIRELY VOLUNTARY CARE | RR 0.97 [0.62, 1.52] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Participant level outcomes: 2. Social functioning: trouble with police by 11 to 12 months, ever arrested/picked up by police for violence against a person COURT ORDERED OUTPATIENT COMMITMENT vs ENTIRELY VOLUNTARY CARE | RR 0.82 [0.56, 1.21] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Participant level outcomes: 3. Social functioning: homeless by 11 to 12 months COURT ORDERED OUTPATIENT COMMITMENT vs ENTIRELY VOLUNTARY CARE | RR 0.67 [0.39, 1.15] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Participant level outcomes: 5. Quality of life: victimisation by 11 to 12 months COURT ORDERED OUTPATIENT COMMITMENT vs ENTIRELY VOLUNTARY CARE | RR 0.5 [0.31, 0.8] | 1 study · 264 participants | Low Downgraded: risk of bias |
Participant level outcomes: 6. Satisfaction with care/adverse events: perceived coercion by 11 to 12 months COURT ORDERED OUTPATIENT COMMITMENT vs ENTIRELY VOLUNTARY CARE | RR 1.36 [0.97, 1.89] | 2 studies · 416 participants | Low Downgraded: risk of bias |
COMMUNITY TREATMENT ORDERS compared with SUPERVISED DISCHARGE (SECTION 17) for people with severe mental disorders
Population: people with severe mental disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Health service outcomes: 1. Readmission to hospital by 12 months COMMUNITY TREATMENT ORDERS vs SUPERVISED DISCHARGE (SECTION 17) | RR 0.99 [0.74, 1.32] | 1 study · 333 participants | Moderate |
Health service outcomes: 2. Hospital bed‐days by 12 months COMMUNITY TREATMENT ORDERS vs SUPERVISED DISCHARGE (SECTION 17) | no estimate extracted | 1 study · 333 participants | Moderate |
Health service outcomes: 3. Number of readmissions by 12 months COMMUNITY TREATMENT ORDERS vs SUPERVISED DISCHARGE (SECTION 17) | no estimate extracted | 1 study · 119 participants | Moderate |
Health service outcomes: 4. Number with multiple readmissions by 12 months COMMUNITY TREATMENT ORDERS vs SUPERVISED DISCHARGE (SECTION 17) | RR 0.56 [0.27, 1.17] | 1 study · 333 participants | Moderate |
Health service outcomes: 5. Days in community to first admission by 12 months COMMUNITY TREATMENT ORDERS vs SUPERVISED DISCHARGE (SECTION 17) | no estimate extracted | 1 study · 333 participants | Moderate |
Participant level outcomes: 1. Mental state ‐ psychiatric symptoms at 12 months (BPRS) COMMUNITY TREATMENT ORDERS vs SUPERVISED DISCHARGE (SECTION 17) | no estimate extracted | 1 study · 234 participants | Moderate |
Participant level outcomes: 3. Satisfaction with care: perceived coercion at 11 ‐ 12 months COMMUNITY TREATMENT ORDERS vs SUPERVISED DISCHARGE (SECTION 17) | no estimate extracted | 1 study · 182 participants | Moderate |
COMPULSORY COMMUNITY TREATMENT compared with STANDARD CARE for people with severe mental disorders
Population: people with severe mental disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Health service outcomes: 1. Readmission to hospital by 11 to 12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.98 [0.83, 1.17] | 3 studies · 749 participants | Moderate |
Health service outcomes: 2. Hospital bed‐days COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | no estimate extracted | 2 studies · 597 participants | Moderate |
Health service outcomes: 3. Number with multiple readmissions by 12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 1 [0.6, 1.66] | 2 studies · 485 participants | Moderate |
Participant level outcomes: 1. Global state: GAF at 12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | no estimate extracted | 2 studies · 335 participants | Moderate |
Participant level outcomes: 2. Satisfaction with care: perceived coercion or leverage at 11 to 12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 1.3 [0.98, 1.71] | 3 studies · 645 participants | Moderate |
COMPULSORY COMMUNITY TREATMENT compared with STANDARD CARE for people with severe mental disorders
Population: people with severe mental disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Health service outcomes: 1. Readmission to hospital ‐ by 11‐12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.98 [0.79, 1.21] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Health service outcomes: 2. Compliance with medication ‐ by 11‐12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.99 [0.83, 1.19] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Patient level outcomes: 1a. Social functioning: trouble with police ‐ by 11‐12 months ‐ at least one arrest COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.97 [0.62, 1.52] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Patient level outcomes: 1a. Social functioning: trouble with police ‐ by 11‐12 months ‐ ever arrested/picked up by police for violence against a person COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.82 [0.56, 1.21] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Patient level outcomes: 1b. Social functioning: homeless ‐ by 11‐12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.67 [0.39, 1.15] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Patient level outcomes: 2. Quality of life: victimisation ‐ by 11‐12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.5 [0.31, 0.8] | 1 study · 264 participants | Low Downgraded: risk of bias, imprecision |
Patient level outcomes: 3. Satisfaction with care/adverse events: perceived coercion ‐ by 11‐12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 1.36 [0.97, 1.89] | 2 studies · 416 participants | Low Downgraded: risk of bias |
COMMUNITY TREATMENT ORDERS compared with SECTION 17 for people with severe mental disorders
Population: people with severe mental disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Health service outcomes: 1. Readmission to hospital ‐ by 12 months COMMUNITY TREATMENT ORDERS vs SECTION 17 | RR 0.99 [0.74, 1.32] | 1 study · 333 participants | Moderate |
Health service outcomes: 2. Total duration of psychiatric hospital stays over12 months COMMUNITY TREATMENT ORDERS vs SECTION 17 | no estimate extracted | 1 study · 333 participants | Moderate |
Health service outcomes: 3. Number of readmissions by 12 months COMMUNITY TREATMENT ORDERS vs SECTION 17 | no estimate extracted | 1 study · 119 participants | Moderate |
Health service outcomes: 4. Number with multiple readmissions by 12 months COMMUNITY TREATMENT ORDERS vs SECTION 17 | RR 0.56 [0.27, 1.17] | 1 study · 333 participants | Moderate |
Days in community till 1st admission COMMUNITY TREATMENT ORDERS vs SECTION 17 | no estimate extracted | 1 study · 333 participants | Moderate |
Patient level outcomes: BPRS COMMUNITY TREATMENT ORDERS vs SECTION 17 | no estimate extracted | 1 study · 234 participants | Moderate |
Patient level outcomes: GAF3 COMMUNITY TREATMENT ORDERS vs SECTION 17 | no estimate extracted | 1 study · 237 participants | Moderate |
COMPULSORY COMMUNITY TREATMENT compared to STANDARD CARE for people with severe mental disorders
Population: patients with people with severe mental disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Health service outcomes: 1. Readmission to hospital ‐ by 11‐12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.98 [0.79, 1.21] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Health service outcomes: 2. Compliance with medication ‐ by 11‐12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.99 [0.83, 1.19] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Patient level outcomes: 1a. Social functioning: trouble with police ‐ by 11‐12 months ‐ at least one arrest COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.97 [0.62, 1.52] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Patient level outcomes: 1a. Social functioning: trouble with police ‐ by 11‐12 months ‐ ever arrested / picked up by police for violence against a person COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.82 [0.56, 1.21] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Patient level outcomes: 1b. Social functioning: homeless ‐ by 11‐12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.67 [0.39, 1.15] | 2 studies · 416 participants | Low Downgraded: risk of bias |
Patient level outcomes: 2. Quality of life: victimisation ‐ by 11‐12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 0.5 [0.31, 0.8] | 1 study · 264 participants | Low Downgraded: risk of bias, imprecision |
Patient level outcomes: 3. Satisfaction with care: perceived coercion ‐ by 11‐12 months COMPULSORY COMMUNITY TREATMENT vs STANDARD CARE | RR 1.36 [0.97, 1.89] | 2 studies · 416 participants | Low Downgraded: risk of bias |