Summary of findings 2. COMMUNITY TREATMENT ORDERS compared with SUPERVISED DISCHARGE (SECTION 17) for people with severe mental disorders.
| COMPULSORY COMMUNITY AND INVOLUNTARY OUTPATIENT TREATMENT FOR PEOPLE WITH SEVERE MENTAL DISORDERS | ||||||
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Patient or population: people with severe mental disorders Settings: community Intervention: COMMUNITY TREATMENT ORDERS Comparison: SUPERVISED DISCHARGE (Section 17) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| SECTION 17 | COMMUNITY TREATMENT ORDERS | |||||
| Health service outcomes: 1. Readmission to hospital by 12 months | Study population | RR 0.99 (0.74 to 1.32) | 333 (1 study) | ⊕⊕⊕⊝ Moderate1,2 | ‐ | |
| 359 per 1000 | 356 per 1000 (266 to 474) | |||||
| Moderate risk population | ||||||
| 359 per 1000 | 355 per 1000 (266 to 474) | |||||
| Health service outcomes: 2. Hospital bed‐days by 12 months | ‐ | The mean health service outcomes: 2. total duration of psychiatric hospital stays over 12 months in the intervention groups was 8.7 lower (30.88 lower to 13.48 higher) | ‐ | 333 (1 study) | ⊕⊕⊕⊝ Moderate1,2 | ‐ |
| Health service outcomes: 3. Number of readmissions by 12 months | ‐ | The mean health service outcomes: 3. number of readmissions by 12 months in the intervention groups was 0.2 lower (0.45 lower to 0.05 higher) | ‐ | 119 (1 study) | ⊕⊕⊕⊝ Moderate1,2 | ‐ |
| Health service outcomes: 4. Number with multiple readmissions by 12 months | Study population | RR 0.56 (0.27 to 1.17) | 333 (1 study) | ⊕⊕⊕⊝ Moderate1,2 | ‐ | |
| 108 per 1000 | 60 per 1000 (29 to 126) | |||||
| Moderate risk population | ||||||
| 108 per 1000 | 60 per 1000 (29 to 126) | |||||
| Health service outcomes: 5. Days in community to first admission by 12 months | ‐ | The mean days in community to 1st admission in the intervention groups was 5 higher (21.74 lower to 31.74 higher) | ‐ | 333 (1 study) | ⊕⊕⊕⊝ Moderate1,2 | ‐ |
| Participant level outcomes: 1. Mental state ‐ psychiatric symptoms at 12 months (BPRS) | ‐ | The mean patierticipant level outcomes: BPRS in the intervention groups was 0.1 lower (3.17 lower to 2.97 higher) | ‐ | 234 (1 study) | ⊕⊕⊕⊝ Moderate1,2 | |
| Participant level outcomes: 3. Satisfaction with care: perceived coercion at 11 ‐ 12 months | ‐ | The mean participant level outcomes: Satisfaction with care: perceived coercion intervention groups was 0.5 lower (1.71 lower to 0.71 higher) | ‐ | 182 (1 study) | ⊕⊕⊕⊝ Moderate1,2 | |
| Other pre‐stated participant level outcomes of interest: Social functioning: trouble with police, homeless; Quality of life: victimisation; not reported | ||||||
| *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). BPRS: Brief Psychiatric Rating Scale; CI: confidence interval; GAF: Global Assessment of Functioning Scale; 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 Forty people (25%) allocated to Section 17 were subsequently placed on a CTO during the study.
2 35 people randomised to CTOs (22%) did not actually receive the intervention.
3 No adverse events reported.