Abstract: The Utility of Outpatient Commitment: A Need for Treatment and a Least Restrictive Alternative to Psychiatric Hospitalization (Society for Social Work and Research 22nd Annual Conference - Achieving Equal Opportunity, Equity, and Justice)

Schedule:

Sunday, January 14, 2018: 8:44 AM

Marquis BR Salon 17 (ML 2) (Marriott Marquis Washington DC)

* noted as presenting author

Steven Segal, PhD, Professor, University of California, Berkeley, Berkeley, CA

Stephania Hayes, MA, Doctoral Student, University of California, Berkeley, Berkeley, CA

Lachlan Rimes, Senior Information Analyst, Department of Health and Human Services, Melbourne, Australia

Objectives: This study determines whether patients assigned to community treatment orders (CTOs), outpatient commitment in Victoria Australia, have a need for treatment to protect their health and safety exceeding that of other psychiatric inpatients. It also considers whether such treatment is provided in a least restrictive manner, i.e. in a way that contributes to reduced use of psychiatric hospitalization.

Method: The sample included 11,424 patients first placed on a CTO between 2000 and 2010, and 16,161 hospitalized patients without CTO placement. Need for treatment was independently assessed with the Health of the Nation Outcome Scale (HoNOS) at the outset and release from psychiatric hospitalization (when CTO placement typically occurred). Logistic regression was used to create a propensity score indicating the patient’s probability of selection into the CTO cohort from the psychiatric inpatient population. OLS and Poisson regression, with propensity score control, was used to assess savings in hospital days attributable to CTO exposure.

Results:HoNOS ratings indicated that at both admission and discharge from hospital,particularly in areas indicating potential dangerous behavior, the CTO cohort’s need for treatment to protect health and safety exceeded that of other psychiatric inpatients. When adjusted for the propensity to be selected into the CTO cohort, demographics, diagnoses, SES, neighborhood disadvantage, aboriginal status, incarceration, mental health system involvements, and psychosocial profile, CTO patients had 4.6 fewer days in average inpatient episode duration over the course of the study period and a reduction of 10.4 days attributable to each CTO placement.

Conclusion: CTO placement enabled patients with a greater need for treatment to spend fewer days per hospitalization episode in an inpatient facility. Whether the CTO enabled the fulfillment of unsought after but required treatment needs that protected patient health and safety are questions that need to be addressed.