Accessing acute medical care to protect health: the utility of community treatment orders

Background The conclusion that people with severe mental llness require involuntary care to protect their health(including threats due to physical-nonpsychiatric-illness)is challenged by findings indicating that they often lack access to general healthcare and the assertionthat theywould access suchcarevoluntarily if available and effective.Victoria,Australia's single-payer healthcare system provides accessible medical treatment;therefore,it is an excellent context in which to test these challenges.AimsThis study replicates aprevious investigation in considering whether,in Australia's easy-access singlepayer healthcare system,patients placed on community treatment orders,specifically involuntary community treatment,are more likelyto access acute medical care addressing potentially life-threatening physical illnesses than voluntary patients with and without severe mental illness.Methods Replicating methods used in 2000-2010,for the years 2010-2017,this study compared the acute medical care access of three new cohorts:7826 hospitalised patientswith severemental illnesswho received a post-hospitalisation,community treatment order;13896 patients with severe mental illness released from the hospital without a community treatment order and 12101outpatients who were never psychiatrically hospitalised(individuals with less morbidity risk who were not considered to have severe mental llness)during periods when they were under versus outside community mental health supervision.Logistic regression was used to determine the influence of community-based community mental health supervision and the type of community mental health supervision(community treatment order vs non-community treatment order)on the likelihood of receiving an initial diagnosis of a life-threatening physical illness requiringacutecare.Results Validating their shared elevated morbidity risk,43.7%and 46.7%,respectively,of each hospitalised cohort(community treatment order and non-community treatment order patients)accessed an initial acute-care diagnosis for a life-threatening condition vs 26.3%of outpatients.Outside community mental health supervision,the likelihood that a community treatment order patient would receive a diagnosis of physical illness was 36%lower than non-community treatment order patients-1.30 times that of outpatients.Under community mental health supervision,their likelihood was two times greater than that of non-community treatment order patients and 6.6 times that of outpatients.Each community treatment order episode was associated with a 14.6% increasein the likelihood of a community treatment order patient receiving a diagnosis.The results replicate those found in an independent 2000-2010 cohort comparison.Conclusions Community mental health supervision,notably community treatment order supervision,in two independent investigations overtwodecades appeared to facilitate access to physical healthcare in acute care settings for patients with severe mental illness who were refusing treatmenta group that has been subject to excess morbidity and mortality.