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      Medidas de seguridad, una reflexión desde la práctica clínica Translated title: Compulsory treatment orders, a reflection from a clinical perspective

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          Abstract

          Resumen: Las medidas de seguridad son medidas de tratamiento obligatorio en régimen ambulatorio o de internamiento que se imponen vía judicial a personas diagnosticadas de alguna patología mental que cometen un delito sin ser plenamente libres y responsables en el momento de la acción delictiva. Exponemos la experiencia práctica de profesionales de distintos dispositivos sanitarios a donde remiten a los pacientes que son penados y tienen que cumplir una medida de seguridad. Reflexionaremos sobre sus posibles efectos en la evolución clínica, las posibles estrategias que se podrían utilizar para que no se tuvieran que llegar a emplear y la necesidad de coordinación con el sistema judicial.

          Translated abstract

          Abstract: Compulsory treatment orders are compulsory outpatient or inpatient treatment orders that are judicially imposed on persons diagnosed with a mental disorder who commit a crime without being fully free and responsible at the time of the criminal action. We present the practical experience of professionals from different health facilities that work with patients who are convicted and must follow a compulsory treatment order. We argue their possible effects on their clinical evolution, the possible strategies that could be used to reduce them and the need for coordination with the judicial system.

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          Most cited references28

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          Risk of Subjection to Violence and Perpetration of Violence in Persons With Psychiatric Disorders in Sweden

          Key Points Question What is the incidence of subjection to violence or perpetration of violence in persons with psychiatric disorders? Findings In this nationwide cohort study of 250 419 individuals with psychiatric disorders in Sweden, in the decade after the onset of their conditions, fewer than 7% of patients had either been subjected to violence severe enough to require specialist medical treatment or had perpetrated violence. Meaning Persons with psychiatric disorders were approximately 3 to 4 times more likely than their siblings without psychiatric disorders to be either subjected to violence or to perpetrate violence.
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            Compulsory community treatment to reduce readmission to hospital and increase engagement with community care in people with mental illness: a systematic review and meta-analysis

            Summary Background Compulsory community treatment (CCT) aims to reduce hospital readmissions among people with mental illness. However, research examining the usefulness of CCT is inconclusive. We aimed to assess the effectiveness of CCT in reducing readmission and length of stay in hospital and increasing community service use and treatment adherence. Methods For this systematic review and meta-analysis, we searched three databases (PsycINFO, MEDLINE and Embase) for quantitative studies on CCT published in English between Jan 1, 1806, and Jan 4, 2018. We included both randomised and non-randomised designs that compared CCT with no CCT, and pre-post designs that compared patients before and after CCT. Studies were eligible if they had been peer-reviewed, if 50% or more of patients had severe mental illness, and if CCT was the intervention. Trials in which CCT was used in response to a criminal offence were excluded. We extracted data on study characteristics and length of follow-up, patient-level data on diagnosis, age, sex, race, and admission history, and outcomes of interest (readmission to hospital, inpatient bed-days, community service use, and treatment adherence) for meta-analysis, for which we extracted summary estimates. We used a random-effects model to compare disparate outcome measures and convert effect size statistics into standardised mean differences. This systematic review is registered with PROSPERO, number CRD42018086232. Findings Of 1931 studies identified, 41 (2%) met inclusion criteria and had sufficient data for analysis. Before and after CCT comparisons showed significant large effects on readmission to hospital (standardised mean difference 0·80, 95% CI 0·53–1·08; I 2=94·74), use of community services (0·83, 0·46–1·21; I 2=87·26), and treatment adherence (2·12, 1·69–2·55; I 2=0), and a medium effect on inpatient bed-days (0·66, 0·46–0·85; I 2=94·12). Contemporaneous controlled comparison studies (randomised and non-randomised) showed no significant effect on readmission, inpatient bed-days, or treatment adherence, but a moderate effect on use of community services (0·38, 0·19–0·58; I 2=96·92). A high degree of variability in study quality was found, with observational study ratings ranging from three to nine. Bias most frequently centred on poor comparability between CCT and control participants. Interpretation We found no consistent evidence that CCT reduces readmission or length of inpatient stay, although it might have some benefit in enforcing use of outpatient treatment or increasing service provision, or both. Future research should focus on why some people do not engage with treatment offered and on enhancing quality of the community care available. Shortcomings of this study include high levels of variability between studies and variation in study quality. Funding National Institute for Health Research.
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              A systematic review of the effect of community treatment orders on service use.

              The evidence regarding community treatment order effectiveness has been conflicting. This systematic review aims to bring up to date the review performed by Churchill and colleagues in 2005 by assessing and interpreting evidence of CTO effectiveness defined by admission rates, number of inpatient days, community service use, and medication adherence published since 2006.
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                Author and article information

                Journal
                neuropsiq
                Revista de la Asociación Española de Neuropsiquiatría
                Rev. Asoc. Esp. Neuropsiq.
                Asociación Española de Neuropsiquiatría (Madrid, Madrid, Spain )
                0211-5735
                2340-2733
                June 2022
                : 42
                : 141
                : 215-226
                Affiliations
                [1] Cartagena Murcia orgnameCentro de Salud Mental de Cartagena España
                [2] Murcia orgnameÁrea VII orgdiv1Equipo de Tratamiento Asertivo Comunitario España
                Article
                S0211-57352022000100215 S0211-5735(22)04214100215
                10.4321/s0211-57352022000100014
                2da486be-25ee-4bd9-89f8-b24ad4c91ec5

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 29 April 2022
                : 09 March 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 12
                Product

                SciELO Spain

                Categories
                Dossier: Atención a la salud mental en prisión

                law enforcement,Involuntary Psychiatric Order,trastornos mentales graves,servicios de salud mental,aplicación de la ley,tratamiento psiquiátrico involuntario,severe mental disorders,mental health services

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