For Inpatient Care, Choice Matters

The United Kingdom is not unlike other countries in that it struggles with a revolving door of inpatient psychiatric care. Individuals who are involuntarily committed to psychiatric facilities often find themselves back in those same facilities after they have been discharged. Measures to decrease inpatient recurrence include leaves of absence, known as Section 17, and community treatment orders (CTOs).

Section 17 stipulates that clients can spend hours, days, or even weeks outside of the psychiatric facility prior to receiving a full discharge. This allows clinicians, family members, caregivers, and clients to determine if they are ready to rejoin society. During this time, outpatient care is voluntary and there is no mandatory monitoring. However, Section 17 has not had a positive impact at reducing readmission.

Therefore, CTOs were introduced several years ago as an alternative to Section 17. Under the CTO provision, clients are under mandatory monitoring and care for a period of time after discharge. During this time, they can be involuntarily readmitted if they are not meeting guidelines for recovery.

Professor Tom Burns of the Department of Psychiatry at the University of Oxford in the United Kingdom wanted to see if CTOs, which are more clinically intensive, reduce the readmission of psychiatric inpatients more than Section 17. To do this, Burns assessed the readmission rates of 333 clients with psychosis and/or schizophrenia after their discharges from psychiatric hospitals. The participants received either 12 months of CTO, which included 183 days of monitoring and outpatient treatment, or 12 months under Section 17, which had only 8 days of treatment. Burns theorized that the Section 17 participants would have a much higher rate of readmission.

Surprisingly, Burns found that 36% of the CTO participants and 36% of the Section 17 participants were readmitted during the 12-month period. This finding is in direct contrast to Burns’ hypothesis and suggests that despite the significant difference in voluntary versus involuntary outpatient treatment, the trend for readmission was the same. Burns believes that involuntary treatment may not provide a benefit big enough to outweigh the cost of personal choice.

Burns concluded by saying, “We found no support in terms of any reduction in overall hospital admission to justify the significant curtailment of patients’ personal liberty.” These results underscore the importance of identifying methods that will effectively reduce the readmission rate of those in psychiatric inpatient care.

Reference:
Burns, Tom, et al. (2013). Community treatment orders for patients with psychosis (OCTET): A randomised controlled trial. The Lancet 381.9878 (2013): 1627-33. ProQuest. Web.

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  • Randy harrison

    Randy harrison

    September 4th, 2013 at 3:55 AM

    I am not sure how I feel about involuntary commitment either, but don’t you think that in some ways it is one of those necessary evils that we have to live with to safeguard society as a whole?

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