Summary of findings for the main comparison. COURT ORDERED OUTPATIENT COMMITMENT compared with ENTIRELY VOLUNTARY CARE for people with severe mental disorders.
| COMPULSORY COMMUNITY AND INVOLUNTARY OUTPATIENT TREATMENT FOR PEOPLE WITH SEVERE MENTAL DISORDERS | ||||||
|
Patient or population: people with severe mental disorders Settings: patients in community settings Intervention: COURT ORDERED OUTPATIENT COMMITMENT Comparison: ENTIRELY VOLUNTARY CARE | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| VOLUNTARY CARE | COURT ORDERED OUTPATIENT COMMITMENT | |||||
| Health service outcomes: 1. Readmission to hospital by 11 to 12 months | Study population | RR 0.98 (0.79 to 1.21) | 416 (2 studies) | ⊕⊕⊝⊝ Low1,2 | ‐ | |
| 460 per 1000 | 451 per 1000 (363 to 557) | |||||
| Medium risk population | ||||||
| 446 per 1000 | 437 per 1000 (352 to 540) | |||||
| Health service outcomes: 4. Compliance with medication by 11 to 12 months | Study population | RR 0.99 (0.83 to 1.19) | 416 (2 studies) | ⊕⊕⊝⊝ Low1,2 | ‐ | |
| 505 per 1000 | 500 per 1000 (419 to 601) | |||||
| Medium risk population | ||||||
| 554 per 1000 | 548 per 1000 (460 to 659) | |||||
| Participant level outcomes: 2. Social functioning: trouble with police by 11 to 12 months, at least 1 arrest | Study population | RR 0.97 (0.62 to 1.52) | 416 (2 studies) | ⊕⊕⊝⊝ Low1,2 | ‐ | |
| 158 per 1000 | 153 per 1000 (98 to 240) | |||||
| Medium risk population | ||||||
| 156 per 1000 | 151 per 1000 (97 to 237) | |||||
| 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 | Study population | RR 0.82 (0.56 to 1.21) | 416 (2 studies) | ⊕⊕⊝⊝ Low1,2 | ‐ | |
| 208 per 1000 | 171 per 1000 (116 to 252) | |||||
| Medium risk population | ||||||
| 156 per 1000 | 128 per 1000 (87 to 189) | |||||
| Participant level outcomes: 3. Social functioning: homeless by 11 to 12 months | Study population | RR 0.67 (0.39 to 1.15) | 416 (2 studies) | ⊕⊕⊝⊝ Low1,2 | ‐ | |
| 134 per 1000 | 90 per 1000 (52 to 154) | |||||
| Medium risk population | ||||||
| 145 per 1000 | 97 per 1000 (57 to 167) | |||||
| Participant level outcomes: 5. Quality of life: victimisation by 11 to 12 months | Study population | RR 0.5 (0.31 to 0.8) | 264 (1 study) | ⊕⊕⊝⊝ Low1,3 | ‐ | |
| 311 per 1000 | 156 per 1000 (96 to 249) | |||||
| Medium risk population | ||||||
| 311 per 1000 | 156 per 1000 (96 to 249) | |||||
| Participant level outcomes: 6. Satisfaction with care/adverse events: perceived coercion by 11 to 12 months | Study population | RR 1.36 (0.97 to 1.89) | 416 (2 studies) | ⊕⊕⊝⊝ Low1,2 | ‐ | |
| 218 per 1000 | 296 per 1000 (211 to 412) | |||||
| Medium risk population | ||||||
| 227 per 1000 | 309 per 1000 (220 to 429) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Allocation concealment and blinding unclear: serious risk of bias, downgraded by one level.
2 Only 2 studies, both from the USA: serious imprecision, downgraded by one level.
3 Only 1 study: serious imprecision, downgraded by one level.