Cultural and linguistic diversity increases the likelihood of compulsory community treatment

Abstract

Background: People from culturally and linguistically diverse (CALD) backgrounds are over-represented in compulsory admissions to hospital but little is known about whether this also applies to community treatment orders (CTOs). Aims: We investigated any differences between Australian- and foreign-born patients in the likelihood of CTO placement using state-wide databases from Western Australia. Methods: Cases and controls from administrative health data were matched on age, sex, diagnosis and time of hospital discharge (the index date). Logistic regression was then used to identify potential predictors of a CTO. We also assessed if any differences in CTO placement between Australian- and foreign-born patients had effects on bed-days or community contacts in the subsequent year. Results: We identified 2958 CTO cases and controls from November 1997 to December 2008 (total n = 5916). Of these, 74% had schizophrenia or other non-affective psychoses. Patients who were born in New Zealand, the United Kingdom or Ireland had very similar rates of CTO placement compared to those who were Australian-born. By contrast, there was a gradient of increasing risk of CTO placement for people born in Continental Europe (ORadj = 1.36; 95% CI = 1.07–1.71, p = 0.01) and then the Rest of the World (ORadj = 1.61; 95% CI = 1.31–1.97, p b 0.001). However, there was no evidence of additional benefit in terms of health service use in the following year. Conclusions: In common with other coercive treatments, people from culturally and linguistically diverse (CALD) backgrounds are more likely to be placed on CTOs. Further research is needed to establish if this is for similar reasons.