Factors influencing the outcomes of Community Treatment Orders: state-wide study using linked administrative health data from New South Wales, Australia

Background The effectiveness of Community Treatment Orders (CTO) and the variability with which they are used remains the subject of ongoing debate. Aims To examine the associations between discharge from psychiatric in-patient care on to a CTO in New South Wales (NSW), Australia, and hospital admissions and bed-days in the following 12 months. Method Retrospective matched case-control study using linked administrative health data from NSW between 1 January 2017 and 31 December 2023. Cases were individuals discharged on to a CTO after their first psychiatric hospital admission during the study period. We attempted to match controls 2:1 on age, gender and hospital discharge within 6 months of each other. Data were from the NSW Mental Health Ambulatory and Admitted Patient Data Collections. Results There were 5506 individuals discharged on to CTOs and 9761 matched controls. Discharge on to a CTO did not affect the odds of hospital readmissions in the following 12 months (adjusted odds ratio (OR adj ) = 1.06, 95% CI 0.97–1.14) though was associated with significantly greater bed-days (log β adj = 0.12, 95% CI 0.08–0.17, p < 0.0001). Individuals with a principal diagnosis of non-affective psychosis who were discharged on to a CTO had significantly lower odds of hospital readmissions in the following 12 months (OR adj = 0.67, 95% CI 0.59–0.77). Conclusions Discharge on to a CTO did not significantly affect hospital readmissions across the full sample, but did significantly lower the odds for individuals with non-affective psychosis. This suggests that targeted use of CTOs in specific populations (e.g., non-affective psychosis) warrants greater consideration, as the benefit of their use otherwise – especially from a human rights point of view – is unclear. Registration Australian and New Zealand Clinical Trials Registry (ACTRN12624000152527).