Cochrane meta-analysis fuels invalid skepticism about compulsory community treatment effectiveness

Background: Quantitative research on non-randomized-samples, focused on statute-mandated-outcomes, has found positive results favoring compulsory-community-treatment (CCT) in jurisdictions fully supporting its implementation. In contrast, three randomized-studies “failed-to-find” a difference between randomly-assigned-CCT and control-groups–each study repeatedly summarized in revisions of a Cochrane-meta-analysis reporting this failure. Considering the potential health and safety threats to people with severe-mental-illness and those with whom they interact, there is a critical need for this investigation to resolve these conflicting results. Method: Using data and procedural-descriptions from the involved-studies, this validity-focused-analysis addressed six questions. Two external-validity focused-questions addressing generalizability of study findings: 1. Did the Cochrane-meta-analysis select studies focused on the CCT-target population? 2. Assuming valid population focus did the Cochrane meta-analysis enroll individuals from among this population fitting the CCT criteria? Four internal-validity-questions: 1. Did the study-designs address the intervention's purpose? 2. Were the outcome-criteria used in the selected-studies valid-indicators of the intervention's intended-outcomes? 3. Were the studies reviewed in the Cochrane-meta-analysis, controlled-trials? And 4. Were the prescribed-Cochrane-Database-statistical-procedures appropriate for evaluating the reviewed-randomized-trials? Results: Focused on completing randomized-investigations, two outpatient-commitment and one CTO-study failed to validly represent the CCT-population, failed to enroll qualifying-subjects, conflated their primary outcome-measure with a required-intervention-procedure, failed to control for post-randomization experiences directly related to their primary-outcome-measure, and conflated the study conditions. Two trials continuously misrepresented themselves as “randomized-controlled-trials”. All relied on univariate-contrasts in evaluating their outcomes, while without post-randomization-control the studies required multivariate-controls for contrasting the outcomes of their intervention-groups. The Cochrane-review, while listing the short-comings of these studies, placing an over-emphasis on prescriptive-methodology, without addressing study substantive-validity, has yielded spurious-conclusions suborning an invalid political-narrative regarding CCT-effectiveness. Conclusions: The “failure-to-find” results from the Cochrane-reviewed-studies can be attributed to research shortcomings rather than intervention-ineffectiveness. The Cochrane-review has promoted undue controversy and skepticism re the use of CCT, a potentially lifesaving-procedure.