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Open Forum   |    
Outpatient Commitment and Its Alternatives: Questions Yet to Be Answered
Joseph P. Morrissey, Ph.D.; Sarah L. Desmarais, Ph.D.; Marisa E. Domino, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201400052
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Dr. Morrissey and Dr. Domino are with the Cecil G. Sheps Center for Health Services Research and the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (e-mail: joe_morrissey@unc.edu). Dr. Desmarais is with the Department of Psychology, North Carolina State University, Raleigh.

Copyright © 2014 by the American Psychiatric Association


This Open Forum reviews research findings on outpatient commitment and alternative approaches, such as conditional hospital release and guardianship. Despite the accumulating evidence in favor of these practices, many questions remain about their essential elements and comparative effectiveness. The authors describe the strengths and shortcomings in existing studies and propose a research strategy that would take advantage of advances in methodologies, such as instrumental variables and propensity weighting, to design studies with a level of rigor comparable to that of randomized controlled trials. The Affordable Care Act (ACA) introduces many opportunities and resources to improve care; studies should also be undertaken to investigate use of outpatient commitment and alternative approaches in the post-ACA health care environment.

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Swanson  JW;  Swartz  MS:  Why the evidence for outpatient commitment is good enough.  Psychiatric Services 65:808–811, 2014
Goldman  HH:  Outpatient commitment reexamined: a third way.  Psychiatric Services 65:816–817, 2014
Morrissey JP, Desmarais SL, Domino ME: Involuntary Outpatient Commitment: Current Evidence and Options. Prepared for the Continuity of Care Panel, Maryland Department of Health and Mental Hygiene, October 2013. Available at dhmh.maryland.gov/bhd/Documents/Morrissey_OPC_Final_Report_%20110413%281%29.pdf
Ridgely  MS;  Petrila  J;  Borum  R:  The Effectiveness of Involuntary Outpatient Treatment: Empirical Evidence and the Experience of Eight States .  Santa Monica, Calif,  RAND, 2001
Kisely  SR;  Campbell  LA;  Preston  NJ:  Compulsory community and involuntary outpatient treatment for people with severe mental disorders.  Cochrane Database of Systematic Reviews 2:CD004408, 2011
O’Reilly  RL;  Gray  JE:  Is mandatory outpatient treatment effective? Canadian Journal of Community Mental Health 24:77–83, 2005
Geller  JL:  The evolution of outpatient commitment in the USA: from conundrum to quagmire.  International Journal of Law and Psychiatry 29:234–248, 2006
Churchill  R;  Owen  G;  Sigh  S  et al:  International Experiences of Using Community Treatment Orders .  London,  King’s College, Institute of Psychiatry, 2007
Steadman  HJ;  Gounis  K;  Dennis  D  et al:  Assessing the New York City involuntary outpatient commitment pilot program.  Psychiatric Services 52:330–336, 2001
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
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
Gilbert  AR;  Moser  LL;  Van Dorn  RA  et al:  Reductions in arrest under assisted outpatient treatment in New York.  Psychiatric Services 61:996–999, 2010
Swanson  JW;  Van Dorn  RA;  Swartz  MS  et al:  The cost of assisted outpatient treatment: can it save states money? American Journal of Psychiatry 170:1423–1432, 2013
Segal  SP;  Burgess  PM:  Conditional release: a less restrictive alternative to hospitalization? Psychiatric Services 57:1600–1606, 2006
Segal  SP;  Burgess  PM:  Effect of conditional release from hospitalization on mortality risk.  Psychiatric Services 57:1607–1613, 2006
Segal  SP;  Burgess  PM:  Factors in the selection of patients for conditional release from their first psychiatric hospitalization.  Psychiatric Services 57:1614–1622, 2006
Segal  SP;  Burgess  PM:  Use of community treatment orders to prevent psychiatric hospitalization.  Australian and New Zealand Journal of Psychiatry 42:732–739, 2008
Segal  SP;  Preston  N;  Kisely  S  et al:  Conditional release in Western Australia: effect on hospital length of stay.  Psychiatric Services 60:94–99, 2009
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
No Relevance to Assisted Outpatient Treatment (AOT) in the OCTET Study of English Compulsory Treatment.  Arlington, Va,  Treatment Advocacy Center, 2013. Available at www.treatmentadvocacycenter.org/storage/documents/Research/may2013-octet-study.pdf
Bloom  JD;  Faulkner  LR:  Competency determinations in civil commitment.  American Journal of Psychiatry 144:193–196, 1987
Geller  JL;  McDermeit  M;  Grudzinskas  AJ  Jr  et al:  A competency-based approach to court-ordered outpatient treatment.  New Directions for Mental Health Services 75:81–95, 1997
Lawlor  T;  Grudzinskas  AJ  Jr;  Geller  JL  et al:  A competency-based approach to managing violence with involuntary outpatient treatment.  Administration and Policy in Mental Health and Mental Health Services Research 34:315–318, 2007
Appelbaum  PS;  Gutheil  TG:  Clinical Handbook of Psychiatry and the Law , 4th ed.  Philadelphia,  Lippincott/Williams and Wilkins, 2007
Dawson  J;  Szmukler  G:  Fusion of mental health and incapacity legislation.  British Journal of Psychiatry 188:504–509, 2006
Lamb  HR;  Weinberger  LE:  Conservatorship for gravely disabled psychiatric patients: a four-year follow-up study.  American Journal of Psychiatry 149:909–913, 1992
Geller  J;  Grudzinskas  AJ  Jr;  McDermeit  M  et al:  The efficacy of involuntary outpatient treatment in Massachusetts.  Administration and Policy in Mental Health and Mental Health Services Research 25:271–285, 1998
Hatfield  B;  Shaw  J;  Pinfold  V  et al:  Managing severe mental illness in the community using the Mental Health Act 1983: a comparison of Supervised Discharge and Guardianship in England.  Social Psychiatry and Psychiatric Epidemiology 36:508–515, 2001
Garfield  RL;  Zuvekas  SH;  Lave  JR  et al:  The impact of national health care reform on adults with severe mental disorders.  American Journal of Psychiatry 168:486–494, 2011
Mechanic  D:  Seizing opportunities under the Affordable Care Act for transforming the mental and behavioral health system.  Health Affairs 31:376–382, 2012
Thomas  KC;  Ellis  AR;  Konrad  TR  et al:  County-level estimates of mental health professional shortage in the United States.  Psychiatric Services 60:1323–1328, 2009
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