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Why the Evidence for Outpatient Commitment Is Good Enough
Jeffrey W. Swanson, Ph.D.; Marvin S. Swartz, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300424
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Dr. Swanson and Dr. Swartz are with the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (e-mail: jeffrey.swanson@duke.edu).

Copyright © 2014 by the American Psychiatric Association

Abstract

After nearly three decades of studies evaluating the legal practice of involuntary outpatient commitment, there is yet little consensus about its effectiveness and only limited implementation. Debate continues over how best to assist adults with serious mental illnesses who are unable or unwilling to participate in prescribed community treatment and as a result experience repeated involuntary hospitalizations or involvement with the criminal justice system. The authors comment on the Oxford Community Treatment Order Evaluation Trial (OCTET), a recently conducted randomized trial of outpatient commitment, and discuss the limitations of the study’s design for resolving the persistent question of whether compulsory treatment is more effective than purely voluntary treatment for this difficult-to-reach target population. The authors conclude that the search for a definitive and generalizable randomized trial of outpatient commitment may be a quixotic quest; the field should, rather, welcome the results of well-conducted, large-scale, quasi-experimental and naturalistic studies with rigorous multivariable statistical controls.

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References

Miller  RD:  Outpatient civil commitment of the mentally ill: an overview and an update.  Behavioral Sciences and the Law 6:99–118, 1988
 
Geller  JL:  The evolution of outpatient commitment in the USA: from conundrum to quagmire.  International Journal of Law and Psychiatry 29:234–248, 2006
 
Robbins  PC;  Keator  KJ;  Steadman  HJ  et al:  Assisted outpatient treatment in New York: regional differences in New York’s assisted outpatient treatment program.  Psychiatric Services 61:970–975, 2010
 
Petrila  J;  Ridgely  S;  Borum  R:  Debating outpatient commitment: controversy, trends, and empirical data.  Crime and Delinquency 49:157–172, 2003
 
Wagenaar  AC;  Komro  KA:  Natural experiments: research design elements for optimal causal inference without randomization; in  Public Health Law Research: Theory and Methods . Edited by Wagenaar  AC;  Burris  SC.  San Francisco,  Jossey-Bass, 2013
 
Swartz  MS;  Swanson  JW;  Wagner  HR  et al:  Can involuntary outpatient commitment reduce hospital recidivism? Findings from a randomized trial with severely mentally ill individuals.  American Journal of Psychiatry 156:1968–1975, 1999
 
Steadman  HJ;  Gounis  K;  Dennis  D  et al:  Assessing the New York City involuntary outpatient commitment pilot program.  Psychiatric Services 52:330–336, 2001
 
Burns  T;  Rugkåsa  J;  Molodynski  A  et al:  Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial.  Lancet 381:1627–1633, 2013
 
Kisely  S;  Campbell  LA;  Preston  N:  Compulsory community and involuntary outpatient treatment for patients with severe mental disorders.  Cochrane Database of Systematic Reviews 2:CD004408, 2011
 
Mental Health Act 2007, Part 1, Chapter 4: Community Treatment Orders. Available at www.legislation.gov.uk/ukpga/2007/12/part/1/chapter/4. Accessed Sept 15, 2013
 
Mental Health Act 1983, Chapter 20, Section 17: Leave of Absence From Hospital. Available at www.legislation.gov.uk/ukpga/1983/20/section/17. Accessed Sept 15, 2013
 
Mental Health Act Section 17: Guidance for the Use of Section 17 Leave. Available at www.corecarestandards.co.uk/EasySiteWeb/GatewayLink.aspx?alId=4279. Accessed March 25, 2014
 
Nakhost  A;  Perry  JC;  Simpson  AI:  Community treatment orders for patients with psychosis.  Lancet 382:501, 2013
 
McCutcheon  R:  Community treatment orders for patients with psychosis.  Lancet 382:501, 2013
 
Naudet  F;  El Sanharawi  M:  Community treatment orders for patients with psychosis.  Lancet 382:501–502, 2013
 
Geller  J:  Community treatment orders for patients with psychosis.  Lancet 382:502, 2013
 
Swartz  MS;  Wilder  CM;  Swanson  JW  et al:  Assessing outcomes for consumers in New York’s assisted outpatient treatment program.  Psychiatric Services 61:976–981, 2010
 
Swanson  JW:  What would Mary Douglas do? A commentary on Kahan et al, “Cultural Cognition and Public Policy: The Case of Outpatient Commitment Laws.” Law and Human Behavior 34:176–185, 2010
 
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