The utility of outpatient commitment: acute medical care access and protecting health

  • Steven P. Segal
  • Stephania L. Hayes
  • Lachlan Rimes
Original Paper



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.


Outpatient 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.

Supplementary material

127_2018_1510_MOESM1_ESM.docx (49 kb)
Supplementary material 1 (DOCX 48 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of California, BerkeleyBerkeleyUSA
  2. 2.University of MelbourneMelbourneAustralia
  3. 3.Victoria Department of Health and Human ServicesMelbourneAustralia

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