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More Evidence on the Effectiveness of Outpatient Committment

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The current issue of Psychiatric Services provides further evidence that outpatient commitment programs such as Kendra's Law can be effective in managing the mental health treatment needs of those with severe mental illnesses with histories of violence or repeated involuntary hospitalizations:

OBJECTIVE: Outpatient commitment has been heralded as a necessary intervention that improves psychiatric outcomes and quality of life, and it has been criticized on the grounds that effective treatment must be voluntary and that outpatient commitment has negative unintended consequences. Because few methodologically strong data exist, this study evaluated New York State's outpatient commitment program with the objective of augmenting the existing literature. METHODS: A total of 76 individuals recently mandated to outpatient commitment and 108 individuals (comparison group) recently discharged from psychiatric hospitals in the Bronx and Queens who were attending the same outpatient facilities as the group mandated to outpatient commitment were followed for one year and compared in regard to psychotic symptoms, suicide risk, serious violence perpetration, quality of life, illness-related social functioning, and perceived coercion and stigma. Propensity score matching and generalized estimating equations were used to achieve the strongest causal inference possible without an experimental design. RESULTS: Serious violence perpetration and suicide risk were lower and illness-related social functioning was higher (p<.05 for all) in the outpatient commitment group than in the comparison group. Psychotic symptoms and quality of life did not differ significantly between the two groups. Potential unintended consequences were not evident: the outpatient commitment group reported marginally less (p<.10) stigma and coercion than the comparison group. CONCLUSIONS: Outpatient commitment in New York State affects many lives; therefore, it is reassuring that negative consequences were not observed. Rather, people's lives seem modestly improved by outpatient commitment. However, because outpatient commitment included treatment and other enhancements, these findings should be interpreted in terms of the overall impact of outpatient commitment, not of legal coercion per se. As such, the results do not support the expansion of coercion in psychiatric treatment.
Critics of outpatient commitment contend that these programs are not a panacea.  And they surely are correct.  But the "on the ground" reality of providing care for folks with these difficult issues often comes down to a short range of choices which include some form of involuntary treatment, incarceration, or severe neglect.  Out of these options, outpatient commitment has the right aims and accumulating evidence of modest success. 

1 Comment

I am always puzzled by people who say something is "not a panacea" and think they have scored a point. There are no panaceas. If a particular measure's not being a panacea is a reason not to do it, then we would do nothing.

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