International Journal of Law and Psychiatry 74 (2021) 101664 0160-2527/© 2020 Elsevier Ltd. All rights reserved. The association between discontinuation of community treatment orders and outcomes in the 12-months following discharge from residential mental health rehabilitation Stephen Parker a, d, * , Urska Arnautovska b , Gemma McKeon c, e , Steve Kisely d a Staff Specialist – Psychiatry Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, Australia b Senior Research Officer PA Foundation, Princess Alexandra Hospital, Brisbane, Australia c Clinical Neuropsychologist and Clinical Psychologist Child and Youth Mental Health Group, QIMR Berghofer Medical Research Institute, Australia d Faculty of Medicine, University of Queensland, School of Public Health, Herston, Australia e Psychosis ACU, Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, Australia A R T I C L E INFO Keywords: Community treatment order Severe mental illness Schizophrenia Recovery-oriented services Community mental health ABSTRACT To compare the post-discharge outcomes of people admitted to community-based residential mental health rehabilitation facilities subject to a Community Treatment Order (CTO) who do and do not have this order discontinued prior to discharge. People subject to a CTO who were admitted across five Community Care Units (CCUs) in Queensland, Australia between 2005 and 2014 (N = 311), were grouped based on involuntary treatment status at the time of their discharge. Individuals whose status changed to voluntary (n = 63; CTO > VOL) were compared with those whose treatment remained involuntary (n = 248; CTO-CTO) on demographic, clinical and treatment-related characteristics. Group-level and individualised changes were assessed between the year pre-admission and the year post-discharge. The primary outcome measure was change in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes included disability (Life Skills Profile-16), service use, ac- commodation instability, and involuntary treatment. Logistic regression was completed to examine predictors of CTO discontinuation during CCU care. Potential predictors covered service-, consumer-, and treatment-related characteristics. Compared to the CTO-CTO group, the CTO > VOL group had significantly longer episodes of CCU care, more frequent primary diagnoses of schizophrenia spectrum disorders, and were more likely to be female. Following discharge, CTO > VOL subjects had more frequent reliable and clinically significant improvement in HoNOS scores, as well as more frequently demonstrated reliable improvement in hospital bed use and accommodation instability than the CTO-CTO subjects. CTO discontinuation was predicted by longer duration of CCU care, being a female, and having a smaller number of psychiatry-related bed use prior admission. Our findings suggest that CCU care of sufficient duration may lessen the need for subsequent compulsory treatment in the community. 1. Introduction There has been increasing debate about the role of Community Treatment Orders (CTOs) in improving the outcomes for people affected by Severe and Persistent Mental Illness (SPMI) (Barnett et al., 2018; Brophy, Kokanovi´c, Flore, McSherry, & Herrman, 2019; Gill et al., 2020; Kisely et al., 2017; Light, Kerridge, Ryan, & Robertson, 2012; Maughan, Molodynski, Rugkåsa, & Burns, 2014). These orders allow for the involuntary treatment of a person diagnosed with a mental illness who is living in the community. Rates of CTO use in Australia are among the highest in the world (Light, 2019). Despite limited evidence of the effectiveness of CTOs (Light, 2019; Barnett et al., 2018; Kisely et al., 2017), some authors believe they are necessary for ensuring the safety of the person subject to the order and the community (Corring, O’Reilly, Sommerdyk, & Russell, 2018). Concern has also been expressed that the increasing use of CTOs may reflect clinicians’ efforts to ensure access to * Corresponding author at: 199 Ipswich Road, Woolloongabba, Queensland 4102, Australia. E-mail address: stephen.parker@health.qld.gov.au (S. Parker). Contents lists available at ScienceDirect International Journal of Law and Psychiatry journal homepage: www.elsevier.com/locate/ijlawpsy https://doi.org/10.1016/j.ijlp.2020.101664 Received 27 August 2020; Received in revised form 29 October 2020; Accepted 26 November 2020