Griffith Criminology Institute, Griffith University, Australia.
Griffith Criminology Institute, Griffith University, Australia; School of Medicine, The University of Queensland and Princess Alexandra Hospital, Woolloongabba, QLD, Australia; Metro South Health Service, Woolloongabba, QLD, Australia.
Int J Law Psychiatry. 2022 Jul-Aug;83:101813. doi: 10.1016/j.ijlp.2022.101813. Epub 2022 Jun 24.
Most studies on the predictors and effectiveness of community treatment orders (CTOs) are restricted to health-related variables and do not consider forensic contacts as established by criminal justice databases or predictors from birth. We used linked administrative health and criminal justice data for a birth cohort in Queensland, Australia to investigate the characteristics and outcomes of people placed on CTOs.
CTOs were identified from administrative data for hospital admissions and community mental health service contacts for a population cohort of 45,141 individuals born in Queensland in 1990. These data were linked with administrative court records, with individuals followed up to age 23/24 years. Logistic regression analyses were used to examine characteristics associated with CTO placement and Tobit regression analyses to examine factors predicting health and criminal justice outcomes in the following year.
There were 211 CTO cases by age 23/24 years, for whom it was possible to identify 413 controls on voluntary treatment. Non-affective psychoses [F20-F29] were the strongest predictors of CTO placement (OR = 4.07, 2.77-5.99) followed by a court appearance (OR = 1.99, 1.28-3.09). CTOs were associated with greater, not lower, subsequent psychiatric hospital admissions, inpatient bed-days and community mental health service contacts, although on sensitivity analyses psychiatric hospital admissions were the same as voluntary controls. CTOs were not associated with more subsequent court appearances despite higher rates of offending before CTO placement.
Both clinical and forensic variables can determine CTO placement and, on adjustment for these covariates, CTOs were not associated with reductions in psychiatric hospital admission, time spent as an inpatient, or subsequent court appearances. The latter finding might mean that CTOs reduce the risk of offending to that of voluntary controls.
大多数关于社区治疗令（CTO）的预测因素和效果的研究都仅限于与健康相关的变量，而不考虑刑事司法数据库中建立的法医接触或出生时的预测因素。我们使用澳大利亚昆士兰州一个出生队列的链接行政卫生和刑事司法数据，调查了被安置在 CTO 上的人的特征和结果。
通过对出生于昆士兰州的 45141 人在医院就诊和社区心理健康服务接触的行政数据，确定了 CTO。这些数据与行政法庭记录相关联，对个体进行了随访，直到 23/24 岁。使用逻辑回归分析来检查与 CTO 安置相关的特征，使用 Tobit 回归分析来检查次年健康和刑事司法结果的预测因素。
在 23/24 岁时，有 211 例 CTO 病例，其中有 413 例可识别为自愿治疗的对照。非情感性精神病（F20-F29）是 CTO 安置的最强预测因素（OR=4.07，2.77-5.99），其次是法庭出庭（OR=1.99，1.28-3.09）。CTO 与随后的精神病院入院、住院天数和社区心理健康服务接触的增加有关，而不是减少，尽管在敏感性分析中，精神病院入院与自愿对照相同。尽管 CTO 安置前的犯罪率较高，但 CTO 与随后的法庭出庭次数没有增加。
临床和法医变量都可以确定 CTO 的安置，在调整这些协变量后，CTO 与减少精神病院入院、住院时间或随后的法庭出庭次数无关。后一种发现可能意味着 CTO 降低了犯罪风险，使其与自愿对照相同。
