Letters to the Editor
Reply: Ann-Marie O’Brien Responds
Dear Editor: We wish to thank Dr Kisely for his interest in our study. We sincerely apologize for including Dr Kisely’s study in the group with others described as “small sample.” As Dr Kisely has pointed out, his study included 456 patients (1). We must clarify that we did not refer to Australian studies twice, as Dr Kisely stated: we referenced 3 Australian papers (1–3).
We did not say that Australian studies demonstrated reduced hospital use in patients on community treatment orders (CTOs), as Dr Kisely suggests. Rather, we stated “Our study findings are consistent with studies in the US and Australia that demonstrate reduced hospital use and increased use of other supportive services” (4, p 29). We stand by this statement and remind Dr Kisely that his own study demonstrated a significant increase in follow-up in the patients who were on CTOs (1). Conclusions based on our study are for subjects in our study. We do not presuppose increased generalizability. There is no incorrect interpretation of our results; instead, we provide a thematic review of others.
CTOs occur within distinct cultural contexts that have largely been ignored in the scientific literature. In Canada, clinicians and policy-makers have made decisions about the usefulness of CTOs, based on outcome studies conducted within cultural contexts significantly different from our own. The value of this study is that it is the first published outcome study using Canadian data.
References
1. Preston, Neil J, Kisely S, Xiao J. Assessing the outcome of compulsory psychiatric treatment in the Community: Epidemiological Study in Western Australia. BMJ 2002;324:1244.
2. Vaughan K, McConaghy N, Wolf C, Myhr, C, Black T. Community treatment orders: relationship to clinical care, medication compliance, behavioral disturbance, and readmission. Aust N Z J Psychiatry 2000;34:801–8.
3. Power P. Community treatment orders: the Australian experience. The Journal of Forensic Psychiatry 1999;10:9–15.
4. O’Brien A-M, Farrell SJ. Community treatment orders: profile of a Canadian experience. Can J Psychiatry 2005;49:27–30
Ann-Marie O’Brien, MSW RSW
Ottawa, Ontario
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