Factors influencing the outcomes of Community Treatment Orders: state-wide study using linked administrative health data from New South Wales, Australia

BJPsych Open. 2026 Mar 10;12(2):e82. doi: 10.1192/bjo.2026.10987.

ABSTRACT

BACKGROUND: The effectiveness of Community Treatment Orders (CTO) and the variability with which they are used remains the subject of ongoing debate.

AIMS: To examine the associations between discharge from psychiatric in-patient care on to a CTO in New South Wales (NSW), Australia, and hospital admissions and bed-days in the following 12 months.

METHOD: Retrospective matched case-control study using linked administrative health data from NSW between 1 January 2017 and 31 December 2023. Cases were individuals discharged on to a CTO after their first psychiatric hospital admission during the study period. We attempted to match controls 2:1 on age, gender and hospital discharge within 6 months of each other. Data were from the NSW Mental Health Ambulatory and Admitted Patient Data Collections.

RESULTS: There were 5506 individuals discharged on to CTOs and 9761 matched controls. Discharge on to a CTO did not affect the odds of hospital readmissions in the following 12 months (adjusted odds ratio (OR_adj) = 1.06, 95% CI 0.97-1.14) though was associated with significantly greater bed-days (log β_adj = 0.12, 95% CI 0.08-0.17, p < 0.0001). Individuals with a principal diagnosis of non-affective psychosis who were discharged on to a CTO had significantly lower odds of hospital readmissions in the following 12 months (OR_adj = 0.67, 95% CI 0.59-0.77).

CONCLUSIONS: Discharge on to a CTO did not significantly affect hospital readmissions across the full sample, but did significantly lower the odds for individuals with non-affective psychosis. This suggests that targeted use of CTOs in specific populations (e.g., non-affective psychosis) warrants greater consideration, as the benefit of their use otherwise – especially from a human rights point of view – is unclear.

REGISTRATION: Australian and New Zealand Clinical Trials Registry (ACTRN12624000152527).

PMID:41804258 | DOI:10.1192/bjo.2026.10987