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Conditional Release in Western Australia: Effect on Hospital Length of Stay

Dr. Segal is affiliated with the School of Social Welfare, University of California, 120 Haviland Hall (MC 7400), Berkeley, CA 94720-7400 (e-mail: spsegal{at}berkeley.edu). Dr. Preston is with the South Metropolitan Area Mental Health Service, Perth, Western Australia. Dr. Kisely is with the School of Medicine, Griffith University, Logan Campus, Queensland, Australia. Dr. Xiao is with the Epidemiology Branch, Department of Health WA, Perth, Western Australia.

OBJECTIVE: The goal of this study was to determine whether the introduction of community treatment orders, which allow for conditional release from a psychiatric hospital, reduced inpatient episode durations in Western Australia by providing an alternative to extended inpatient stays. METHODS: The design compared 129 persons given community treatment orders and 117 matched control patients without such orders—all of whom were hospitalized during the same period both before and after the introduction of the community treatment order law that allows for conditional release. A multivariate analysis of covariance was used to evaluate the impact of community treatment orders on change in inpatient episode duration. RESULTS: The model showed a significant effect on inpatient episode duration (R²=.23, adjusted R²=.17, N=243, F=3.99, df=17 and 226, p<.001), indicating that community treatment orders (after taking all control factors into account) enabled a 19.16-day reduction per episode of inpatient care (t=2.13, df=1, p=.034) for persons given conditional release. Community-initiated treatment orders intended to prevent hospitalization, yet failing to do so, were associated with increased duration of subsequent hospitalizations (35.18 days; t=–3.36, df=1, p<.001). CONCLUSIONS: Community treatment orders can be a useful tool for some but not necessarily all objectives. In the form of conditional release, orders reduce the likelihood of extended hospital stays. As a means to prevent hospitalization, the utility of community treatment orders is more complex, being dependent on services provided and on the judicious selection of persons for these orders.

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