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Community treatment orders in a Swedish county - applied as intended?
BACKGROUND: Community treatment orders (CTOs) were legally implemented in psychiatry in Sweden in 2008, both in general psychiatry and in forensic psychiatric care. A main aim with the reform was to replace long leaves from compulsory psychiatric inpatient care with CTOs. The aims of the present stu...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307113/ https://www.ncbi.nlm.nih.gov/pubmed/25480121 http://dx.doi.org/10.1186/1756-0500-7-879 |
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author | Kjellin, Lars Pelto-Piri, Veikko |
author_facet | Kjellin, Lars Pelto-Piri, Veikko |
author_sort | Kjellin, Lars |
collection | PubMed |
description | BACKGROUND: Community treatment orders (CTOs) were legally implemented in psychiatry in Sweden in 2008, both in general psychiatry and in forensic psychiatric care. A main aim with the reform was to replace long leaves from compulsory psychiatric inpatient care with CTOs. The aims of the present study were to examine the use of compulsory psychiatric care before and after the reform and if this intention of the law reform was fulfilled. METHODS: The study was based on register data from the computerized patient administrative system of Örebro County Council. Two periods of time, two years before (I) and two years after (II) the legal change, were compared. The Swedish civic registration number was used to connect unique individuals to continuous treatment episodes comprising different forms of legal status and to identify individuals treated during both time periods. RESULTS: The number of involuntarily admitted patients was 524 in period I and 514 in period II. CTOs were in period II used on relatively more patients in forensic psychiatric care than in general psychiatry. In all, there was a 9% decrease from period I to period II in hospital days of compulsory psychiatric care, while days on leave decreased with 60%. The number of days on leave plus days under CTOs was 26% higher in period II than the number of days on leave in period I. Among patients treated in both periods, this increase was 43%. The total number of days under any form of compulsory care (in hospital, on leave, and under CTOs) increased with five percent. Patients with the longest leaves before the reform had more days on CTOs after the reform than other patients. CONCLUSIONS: The results indicate that the main intention of the legislator with introducing CTOs was fulfilled in the first two years after the reform in the studied county. At the same time the use of coercive psychiatric care outside hospital, and to some extent the total use of coercive in- and outpatient psychiatric care, increased. Adding an additional legal coercive instrument in psychiatry may increase the total use of coercion. |
format | Online Article Text |
id | pubmed-4307113 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-43071132015-01-28 Community treatment orders in a Swedish county - applied as intended? Kjellin, Lars Pelto-Piri, Veikko BMC Res Notes Research Article BACKGROUND: Community treatment orders (CTOs) were legally implemented in psychiatry in Sweden in 2008, both in general psychiatry and in forensic psychiatric care. A main aim with the reform was to replace long leaves from compulsory psychiatric inpatient care with CTOs. The aims of the present study were to examine the use of compulsory psychiatric care before and after the reform and if this intention of the law reform was fulfilled. METHODS: The study was based on register data from the computerized patient administrative system of Örebro County Council. Two periods of time, two years before (I) and two years after (II) the legal change, were compared. The Swedish civic registration number was used to connect unique individuals to continuous treatment episodes comprising different forms of legal status and to identify individuals treated during both time periods. RESULTS: The number of involuntarily admitted patients was 524 in period I and 514 in period II. CTOs were in period II used on relatively more patients in forensic psychiatric care than in general psychiatry. In all, there was a 9% decrease from period I to period II in hospital days of compulsory psychiatric care, while days on leave decreased with 60%. The number of days on leave plus days under CTOs was 26% higher in period II than the number of days on leave in period I. Among patients treated in both periods, this increase was 43%. The total number of days under any form of compulsory care (in hospital, on leave, and under CTOs) increased with five percent. Patients with the longest leaves before the reform had more days on CTOs after the reform than other patients. CONCLUSIONS: The results indicate that the main intention of the legislator with introducing CTOs was fulfilled in the first two years after the reform in the studied county. At the same time the use of coercive psychiatric care outside hospital, and to some extent the total use of coercive in- and outpatient psychiatric care, increased. Adding an additional legal coercive instrument in psychiatry may increase the total use of coercion. BioMed Central 2014-12-06 /pmc/articles/PMC4307113/ /pubmed/25480121 http://dx.doi.org/10.1186/1756-0500-7-879 Text en © Kjellin and Pelto-Piri; licensee BioMed Central. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Kjellin, Lars Pelto-Piri, Veikko Community treatment orders in a Swedish county - applied as intended? |
title | Community treatment orders in a Swedish county - applied as intended? |
title_full | Community treatment orders in a Swedish county - applied as intended? |
title_fullStr | Community treatment orders in a Swedish county - applied as intended? |
title_full_unstemmed | Community treatment orders in a Swedish county - applied as intended? |
title_short | Community treatment orders in a Swedish county - applied as intended? |
title_sort | community treatment orders in a swedish county - applied as intended? |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307113/ https://www.ncbi.nlm.nih.gov/pubmed/25480121 http://dx.doi.org/10.1186/1756-0500-7-879 |
work_keys_str_mv | AT kjellinlars communitytreatmentordersinaswedishcountyappliedasintended AT peltopiriveikko communitytreatmentordersinaswedishcountyappliedasintended |