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

Abstract

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.