School of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.
Metro South Addiction and Mental Health Services, Metro South Health Service, Woolloongabba, QLD, Australia.
Aust N Z J Psychiatry. 2021 Jul;55(7):650-665. doi: 10.1177/0004867420954286. Epub 2020 Sep 12.
Australia and New Zealand have some of the highest rates of compulsory community treatment order use worldwide. There are also concerns that people from culturally and linguistically diverse backgrounds may have higher rates of community treatment orders. We therefore assessed the health service, clinical and psychosocial outcomes of compulsory community treatment and explored if culturally and linguistically diverse, indigenous status or other factors predicted community treatment orders.
We searched the following databases from inception to January 2020: PubMed/Medline, Embase, CINAHL and PsycINFO. We included any study conducted in Australia or New Zealand that compared people on community treatment orders for severe mental illness with controls receiving voluntary psychiatric treatment. Two reviewers independently extracted data, assessing study quality using Joanna Briggs Institute scales.
A total of 31 publications from 12 studies met inclusion criteria, of which 24 publications could be included in a meta-analysis. Only one was from New Zealand. People who were male, single and not engaged in work, study or home duties were significantly more likely to be subject to a community treatment order. In addition, those from a culturally and linguistically diverse or migrant background were nearly 40% more likely to be on an order. Indigenous status was not associated with community treatment order use in Australia and there were no New Zealand data. Community treatment orders did not reduce readmission rates or bed-days at 12-month follow-up. There was evidence of increased benefit in the longer-term but only after a minimum of 2 years of use. Finally, people on community treatment orders had a lower mortality rate, possibly related to increased community contacts.
People from culturally and linguistically diverse or migrant backgrounds are more likely to be placed on a community treatment order. However, the evidence for effectiveness remains inconclusive and limited to orders of at least 2 years' duration. The restrictive nature of community treatment orders may not be outweighed by the inconclusive evidence for beneficial outcomes.
澳大利亚和新西兰的强制性社区治疗令使用率在全球范围内处于较高水平。也有人担心，来自文化和语言多样化背景的人可能会有更高的社区治疗令率。因此，我们评估了强制性社区治疗的卫生服务、临床和社会心理结局，并探讨了文化和语言多样化、土著身份或其他因素是否预测社区治疗令。
我们从创建到 2020 年 1 月在以下数据库中进行了搜索：PubMed/Medline、Embase、CINAHL 和 PsycINFO。我们纳入了在澳大利亚或新西兰进行的任何比较严重精神疾病患者社区治疗令与自愿接受精神病治疗的对照组的研究。两名评审员独立提取数据，使用 Joanna Briggs 研究所量表评估研究质量。
共有 12 项研究的 31 篇出版物符合纳入标准，其中 24 篇出版物可进行荟萃分析。只有一篇来自新西兰。男性、单身且不从事工作、学习或家庭职责的人更有可能被强制接受社区治疗令。此外，来自文化和语言多样化或移民背景的人被命令接受治疗的可能性增加了近 40%。在澳大利亚，土著身份与社区治疗令的使用无关，新西兰没有相关数据。在 12 个月的随访中，社区治疗令并没有降低再入院率或住院天数。但至少 2 年的使用后，才有证据表明长期效益增加。最后，接受社区治疗令的人的死亡率较低，这可能与增加社区接触有关。
来自文化和语言多样化或移民背景的人更有可能被命令接受社区治疗。然而，其有效性的证据仍不确定，仅限于至少 2 年的命令。社区治疗令的限制性质可能不会超过对有益结果的不确定证据。
