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Review: compulsory community treatment does not improve social functioning or service use in people with severe mental illness

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Is compulsory community treatment for people with severe mental illness clinically effective and cost-effective?


The primary outcomes were health services contact and utilisation (admission to hospital and length of stay) and social functioning (imprisonment, police contact and arrests). Secondary outcomes included remaining in contact with psychiatric services, employment, homelessness, mental state, quality of life, satisfaction with care and adverse events.



Systematic review and meta-analysis.

Data sources

Cochrane Schizophrenia Group Register 2003 and 2008, and the Science Citation Index. Studies listed in the reference lists of identified studies were obtained. Authors of included studies and experts in the field were contacted to identify further studies.

Study selection and analysis

Randomised controlled trials (RCTs) of compulsory community treatment compared with standard care for people with severe mental illness (mainly schizophrenia and schizophrenia-like disorders, bipolar disorder or depression with psychotic features). Studies in people with substance abuse alone were not eligible.

Main results

Two randomised clinical trials (n=416) met inclusion criteria. Both were carried out in the USA, most of the participants had psychosis and about 40% were women. These trials assessed court ordered …

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  • Source of funding No external sources of support were received; internal sources of support included the Capital District Health Authority in Canada and other sources.


  • Competing interests None.

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