School of Medicine, The University of Queensland and Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
Metro South Health Service, Woolloongabba, QLD, Australia.
Aust N Z J Psychiatry. 2020 Jan;54(1):76-88. doi: 10.1177/0004867419877690. Epub 2019 Sep 26.
There is conflicting and equivocal evidence for the efficacy of compulsory community treatment within Australia and overseas, but no study from Queensland. In addition, although people from Indigenous or culturally and linguistically diverse backgrounds are over-represented in compulsory admissions to hospital, little is known about whether this also applies to compulsory community treatment.
We initially investigated whether people from Indigenous or culturally and linguistically diverse backgrounds in terms of country of birth, or preferred language, were more likely to be on compulsory community treatment using statewide databases from Queensland. We then assessed the impact of compulsory community treatment on health service use over the following 12 months. Compulsory community treatment included both community treatment orders and forensic orders.
Cases and controls from administrative health data were matched on age, sex, diagnosis and time of hospital discharge (the index date). Multivariate analyses were used to examine potential predictors of compulsory community treatment, as well as impact on bed-days, time to readmission or contacts with public mental health services in the subsequent year.
We identified 7432 cases and controls from January 2013 to February 2017 (total = 14,864). Compulsory community treatment was more likely in Indigenous Queenslanders (adjusted odds ratio = 1.45; 95% confidence interval = [1.28, 1.65]) subjects coming from a culturally and linguistically diverse background (adjusted odds ratio = 1.54; 95% confidence interval = [1.37, 1.72]), or those who had a preferred language other than English (adjusted odds ratio = 1.66; 95% confidence interval = [1.30, 2.11]). While community contacts were significantly greater in patients on compulsory community treatment, there was no difference in bed-days while time to readmission was shorter. Restricting the analyses to just community treatment orders did not alter these results.
In common with other coercive treatments, Indigenous Australians and people from culturally and linguistically diverse backgrounds are more likely to be placed on compulsory community treatment. The evidence for effectiveness remains inconclusive.
在澳大利亚和海外，强制性社区治疗的疗效存在相互矛盾且模棱两可的证据，但昆士兰州没有相关研究。此外，尽管来自原住民或文化和语言多样化背景的人在强制住院治疗中所占比例过高，但对于他们是否也适用于强制性社区治疗，知之甚少。
我们最初使用来自昆士兰州的全州数据库，调查了在出生地或首选语言方面属于原住民或文化和语言多样化背景的人是否更有可能接受强制性社区治疗。然后，我们评估了强制性社区治疗在接下来的 12 个月内对卫生服务使用的影响。强制性社区治疗包括社区治疗令和法医令。
从行政健康数据中匹配病例和对照组，匹配因素包括年龄、性别、诊断和出院时间（索引日期）。多变量分析用于检查强制性社区治疗的潜在预测因素，以及对下一年住院天数、再次入院时间或与公共精神卫生服务的接触次数的影响。
我们从 2013 年 1 月至 2017 年 2 月确定了 7432 例病例和 7432 例对照（共 14864 例）。昆士兰原住民（调整后的优势比=1.45；95%置信区间=[1.28，1.65]）、来自文化和语言多样化背景的个体（调整后的优势比=1.54；95%置信区间=[1.37，1.72]）或首选语言不是英语的个体（调整后的优势比=1.66；95%置信区间=[1.30，2.11]）更有可能接受强制性社区治疗。尽管接受强制性社区治疗的患者社区接触明显更多，但住院天数没有差异，而再次入院时间更短。将分析仅限于社区治疗令并没有改变这些结果。
与其他强制性治疗一样，澳大利亚原住民和文化语言多样化背景的人更有可能接受强制性社区治疗。疗效的证据仍不确定。
