The utility of outpatient commitment: acute medical care access and protecting health
This study considers whether, in an easy access single-payer health care system, patients placed on outpatient commitment—community treatment orders (CTOs) in Victoria Australia—are more likely to access acute medical care addressing physical illness than voluntary patients with and without severe mental illness.
For years 2000 to 2010, the study compared acute medical care access of 27,585 severely mentally ill psychiatrically hospitalized patients (11,424 with and 16,161 without CTO exposure) and 12,229 never psychiatrically hospitalized outpatients (individuals with less morbidity risk as they were not considered to have severe mental illness). Logistic regression was used to determine the influence of the CTO on the likelihood of receiving a diagnosis of physical illness requiring acute care.
Validating their shared and elevated morbidity risk, 53% of each hospitalized cohort accessed acute care compared to 32% of outpatients during the decade. While not under mental health system supervision, however, the likelihood that a CTO patient would receive a physical illness diagnosis was 31% lower than for non-CTO patients, and no different from lower morbidity-risk outpatients without severe mental illness. While, under mental health system supervision, the likelihood that CTO patients would receive a physical illness diagnosis was 40% greater than non-CTO patients and 5.02 times more likely than outpatients were. Each CTO episode was associated with a 4.6% increase in the likelihood of a member of the CTO group receiving a diagnosis.
Mental health system involvement and CTO supervision appeared to facilitate access to physical health care in acute care settings for patients with severe mental illness, a group that has, in the past, been subject to excess morbidity and mortality.
KeywordsOutpatient commitment Community treatment orders Medical care access for the severely mentally ill Physical illness morbidity among psychiatric patients Civil commitment law
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest related to the use or interpretation of the study results.
- 6.National Institute of Mental Health (1991) Caring for people with severe mental disorders: a national plan of research to improve services. Washington, DC: National Institute of Mental Health Contract No.: DDHS Pub. No. (ADM) pp 91–1762Google Scholar
- 7.Parks J, Svendsen D, Singer P, Foti ME (2006) Morbidity and mortality in people with severe mental illness. National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council, Alexandria VAGoogle Scholar
- 8.Wright J, Weber E (1987) Homelessness and health. McGraw-Hill, New YorkGoogle Scholar
- 9.DeHert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I et al (2011) Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatr Off J World Psychiatr Assoc (WPA) 10(1):52–77Google Scholar
- 10.Koyanagi C, Siegwarth A (2009) How will health reform help people with mental illnesses? Bazelon Center for Mental Health Law, Washington, DCGoogle Scholar
- 11.Disability Rights California (2012) Assisted outpatient treatment is unnecessary and efforts should instead be used to ensure increased access to voluntary services. Disability Rights California Legislation and Public Information Unit, editor. Disability Rights California Legislation and Public Information Unit, Sacramento, CAGoogle Scholar
- 12.Carra` G, Bartoli F, Carretta D, Crocamo C, Bozzetti A, Clerici M, Bebbington PE (2014) The prevalence of metabolic syndrome in people with severe mental illness: a mediation analysis. Soc Psychiatry Psychiatr Epidemiol 49:1739–1746. https://doi.org/10.1007/s00127-014-0835-y CrossRefPubMedGoogle Scholar
- 15.Test MA (1992). Training in community living. In: Liberman RP (ed) Handbook of psychiatric rehabilitation. Macmillan, New YorkGoogle Scholar
- 16.New York State Office of Mental Health (2005) Kendra’s law: final report on the status of assisted outpatient treatmentGoogle Scholar
- 18.Kisely S, Preston N, Xiao J, Lawrence D, Louise S, Crowe E (2012) Reducing all-cause mortality among patients with psychiatric disorders: a population-based study. Can Med Assoc J 185(1):E50-6Google Scholar
- 19.Segal SP, Hayes SL, Rimes L (2017). The utility of outpatient commitment: II. Mortality risk, protecting health, safety, and quality of life (APPI-PS-2016-00164.R5). Psychiatr Serv 68(12):1255–1261Google Scholar
- 22.Victoria Legal Aid (2010). Patients’ rights: a self-help guide to Victoria’s mental health act. Melbourne AU: Victoria Legal Aid and Mental Health Legal Centre Inc. p31 http://www.communitylaw.org.au/mentalhealth
- 24.Consumers Health Forum of Australia (2016) Our Health Our Community. http://ourhealth.org.au/rep-support/consumer-reps-guide-australias-health-system/parts-health-system/acute-care#.WAKk_iSPa6M. Accessed 15 Oct 2016
- 25.IBM Corp (2015) IBM SPSS statistics for windows, Version 23.0. IBM Corp, ArmonkGoogle Scholar
- 26.Australian Bureau of Statistics (2011) Technical Paper: Socio-Economic Indexes for Areas (SEIFA) Commonwealth of AustraliaGoogle Scholar