Suicide rates among patients subject to Community Treatment Orders in England, 2009-2018Citation formats

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Suicide rates among patients subject to Community Treatment Orders in England, 2009-2018. / Hunt, Isabelle; Webb, Roger; Turnbull, Pauline; Graney, Jane; Ibrahim, Saied; Shaw, Jenny; Kapur, Nav; Appleby, Louis.

In: BJ Psych Open , 07.09.2021.

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@article{91204910c9fd4304891ff9c7789c9eaa,
title = "Suicide rates among patients subject to Community Treatment Orders in England, 2009-2018",
abstract = "BackgroundCommunity treatment orders (CTOs) enable patients to be treated in the community rather than under detention in hospital. Population-based studies of suicide among patients subject to a CTO are scarce.AimsTo compare suicide rates among patients subject to a CTO with all discharged psychiatric patients and those detained for treatment but not subject to a CTO at discharge ({\textquoteleft}CTO-eligible{\textquoteright} patients).MethodFrom a national case series of patients who died by suicide within 12 months of contact with mental health services in England during 2009–2018, we estimated average annual suicide rates for all discharged patients, those on a CTO at the time of suicide, those ever treated under a CTO and CTO-eligible patients.ResultsSuicide rates for patients on a CTO at the time of suicide (191.3 per 100 000 patients) were lower than all discharged patients (482.3 per 100 000 discharges). Suicide rates were similar in those ever treated under a CTO (350.1 per 100 000 CTOs issued) and in CTO-eligible patients (382.9 per 100 000 discharges). Suicide rates within 12 months of discharge were higher in persons ever under a CTO (205.1 per 100 000 CTOs issued) than CTO-eligible patients (161.5 per 100 000 discharges), but this difference was reversed for rates after 12 months of discharge (153.2 per 100 000 CTOs issued v. 223.4 per 100 000 discharges).ConclusionsCTOs may be effective in reducing suicide risk. The relative benefits of CTOs and intensive aftercare may be time-dependent, with the benefit of a CTO being less before 12 months after discharge but greater thereafter. CTO utilisation requires a careful balancing of patient safety versus autonomy.",
author = "Isabelle Hunt and Roger Webb and Pauline Turnbull and Jane Graney and Saied Ibrahim and Jenny Shaw and Nav Kapur and Louis Appleby",
year = "2021",
month = sep,
day = "7",
doi = "10.1192/bjo.2021.1021",
language = "English",
journal = "BJ Psych Open ",
issn = "2056-4724",
publisher = "Cambridge University Press",

}

RIS

TY - JOUR

T1 - Suicide rates among patients subject to Community Treatment Orders in England, 2009-2018

AU - Hunt, Isabelle

AU - Webb, Roger

AU - Turnbull, Pauline

AU - Graney, Jane

AU - Ibrahim, Saied

AU - Shaw, Jenny

AU - Kapur, Nav

AU - Appleby, Louis

PY - 2021/9/7

Y1 - 2021/9/7

N2 - BackgroundCommunity treatment orders (CTOs) enable patients to be treated in the community rather than under detention in hospital. Population-based studies of suicide among patients subject to a CTO are scarce.AimsTo compare suicide rates among patients subject to a CTO with all discharged psychiatric patients and those detained for treatment but not subject to a CTO at discharge (‘CTO-eligible’ patients).MethodFrom a national case series of patients who died by suicide within 12 months of contact with mental health services in England during 2009–2018, we estimated average annual suicide rates for all discharged patients, those on a CTO at the time of suicide, those ever treated under a CTO and CTO-eligible patients.ResultsSuicide rates for patients on a CTO at the time of suicide (191.3 per 100 000 patients) were lower than all discharged patients (482.3 per 100 000 discharges). Suicide rates were similar in those ever treated under a CTO (350.1 per 100 000 CTOs issued) and in CTO-eligible patients (382.9 per 100 000 discharges). Suicide rates within 12 months of discharge were higher in persons ever under a CTO (205.1 per 100 000 CTOs issued) than CTO-eligible patients (161.5 per 100 000 discharges), but this difference was reversed for rates after 12 months of discharge (153.2 per 100 000 CTOs issued v. 223.4 per 100 000 discharges).ConclusionsCTOs may be effective in reducing suicide risk. The relative benefits of CTOs and intensive aftercare may be time-dependent, with the benefit of a CTO being less before 12 months after discharge but greater thereafter. CTO utilisation requires a careful balancing of patient safety versus autonomy.

AB - BackgroundCommunity treatment orders (CTOs) enable patients to be treated in the community rather than under detention in hospital. Population-based studies of suicide among patients subject to a CTO are scarce.AimsTo compare suicide rates among patients subject to a CTO with all discharged psychiatric patients and those detained for treatment but not subject to a CTO at discharge (‘CTO-eligible’ patients).MethodFrom a national case series of patients who died by suicide within 12 months of contact with mental health services in England during 2009–2018, we estimated average annual suicide rates for all discharged patients, those on a CTO at the time of suicide, those ever treated under a CTO and CTO-eligible patients.ResultsSuicide rates for patients on a CTO at the time of suicide (191.3 per 100 000 patients) were lower than all discharged patients (482.3 per 100 000 discharges). Suicide rates were similar in those ever treated under a CTO (350.1 per 100 000 CTOs issued) and in CTO-eligible patients (382.9 per 100 000 discharges). Suicide rates within 12 months of discharge were higher in persons ever under a CTO (205.1 per 100 000 CTOs issued) than CTO-eligible patients (161.5 per 100 000 discharges), but this difference was reversed for rates after 12 months of discharge (153.2 per 100 000 CTOs issued v. 223.4 per 100 000 discharges).ConclusionsCTOs may be effective in reducing suicide risk. The relative benefits of CTOs and intensive aftercare may be time-dependent, with the benefit of a CTO being less before 12 months after discharge but greater thereafter. CTO utilisation requires a careful balancing of patient safety versus autonomy.

U2 - 10.1192/bjo.2021.1021

DO - 10.1192/bjo.2021.1021

M3 - Article

JO - BJ Psych Open

JF - BJ Psych Open

SN - 2056-4724

ER -