Professor, University of Melbourne, Australia; Professor of the Graduate Division and Director of the Mental Health and Social Welfare Research Group, University of California, Berkeley, USA.
Int J Law Psychiatry. 2020 May-Jun;70:101565. doi: 10.1016/j.ijlp.2020.101565. Epub 2020 May 23.
Outpatient civil commitment (OCC), community treatment orders (CTOs) in European and Commonwealth nations, require the provision of needed-treatment to protect against imminent threats to health and safety. OCC-reviews aggregating all studies report inconsistent outcomes. This review, searches for consistency in OCC-outcomes by evaluating studies based on mental health system characteristics, measurement, and design principles.
All previously reviewed OCC-studies and more recent investigations were grouped by their outcome-measures' relationship to OCC statute objectives. A study's evidence-quality ranking was assessed. Hospital and service-utilization outcomes were grouped by whether they represented treatment provision, patient outcome, or the conflation of both.
OCC-studies including direct health and safety outcomes found OCC associated with reduced mortality-risk, increased access to acute medical care, and reduced violence and victimization risks. Studies considering treatment-provision, found OCC associated with improved medication and service compliance. If coupled with assertive community treatment (ACT) or aggressive case management OCC was associated with enhanced ACT success in reducing hospitalization need. When outpatient-services were limited, OCC facilitated rapid return to hospital for needed-treatment and increased hospital utilization in the absence of a less restrictive alternative. OCC-studies measuring "total hospital days", "prevention of hospitalization", and "readmissions" report negative and/or no difference findings because they erroneously conflate their intervention (provision of needed treatment) and outcome.
This investigation finds replicated beneficial associations between OCC and direct measures of imminent harm indicating reductions in threats to health and safety. It also finds support for OCC as a less restrictive alternative to inpatient care.
门诊民事承诺（OCC），即欧洲和英联邦国家的社区治疗令（CTO），要求提供必要的治疗，以防止对健康和安全的迫在眉睫的威胁。汇总所有研究的 OCC 审查报告显示结果不一致。本研究通过评估基于心理健康系统特征、测量和设计原则的研究，寻找 OCC 结果的一致性。
所有以前审查过的 OCC 研究和最近的调查研究都根据其结果测量与 OCC 法规目标的关系进行分组。评估了研究的证据质量排名。医院和服务利用结果分为治疗提供、患者结果或两者的合并。
包括直接健康和安全结果的 OCC 研究发现，OCC 与降低死亡率、增加获得急性医疗护理以及降低暴力和受害风险相关。考虑治疗提供的研究发现，OCC 与改善药物和服务依从性相关。如果与积极的社区治疗（ACT）或积极的个案管理相结合，OCC 与降低住院需求的 ACT 成功相关。当门诊服务受到限制时，OCC 促进了对所需治疗的快速返回医院，并在没有限制较少的替代方案的情况下增加了医院的利用。测量“总住院天数”、“预防住院”和“再入院”的 OCC 研究报告了负面和/或无差异的发现，因为它们错误地将其干预措施（提供必要的治疗）和结果混淆在一起。
本研究发现，OCC 与直接衡量迫在眉睫的伤害之间存在复制的有益关联，表明对健康和安全的威胁减少。它还支持 OCC 作为住院治疗的限制较少的替代方案。
