Hospital readmission rates in people subject to Community Treatment Orders in Ontario: a review of evidence following the implementation of Brian's Law

Abstract

Background: Community treatment order (CTO) legislation was introduced in the province of Ontario in 2000 with the introduction of Brian’s Law (Bill 68), an amendment to the Mental Health Act spurred by the tragic death of Ottawa sportscaster Brian Smith. CTO’s are a form of involuntary outpatient commitment, targeted at individuals with a history of repeated psychiatric admissions who also meet the criteria of an application for psychiatric assessment. A person subject to a CTO lives in the community under supervision and is required to adhere to various conditions, which often include taking prescribed psychiatric medications and meeting regularly with a psychiatrist. While various forms of CTO’s are used internationally, legal standards and requirements for CTO’s vary by jurisdiction, with Ontario having its own unique set of legislative criteria. Objective: To determine the effect of CTO’s on readmission rates to hospital in persons with mental illness residing in Ontario, Canada. Methods: A structured literature review of English- and French-language peer-reviewed articles published after the year 2000, coinciding with the introduction of CTO’s in Ontario, was conducted on the Cochrane Library, EMBASE, Google Scholar, PsycINFO, PubMed, and grey literature. Conclusion: Ontario CTOs are associated with a marginal effect on readmission rates. Existing Ontario research is outdated and of very low quality.