February 27, 2006

Harvard on Outpatient Commitment

Harvard University's Mental Health Letter has an excellent article on the issue of outpatient commitment in their March 1st issue that has just come out.

In the article they state:

The emptying of mental hospitals began a half-century ago with the hope that effective treatment would be available on the outside, and patients would be willing to accept it. But for many neither of those conditions has been met. Many thousands of so-called revolving-door patients consume a disproportionate share of the resources of the health care and criminal justice systems as they move between jails, prisons, emergency rooms, psychiatric hospitals, rented rooms, group homes, and the street.

At any given time, a third to half of people with schizophrenia or bipolar disorder are not receiving treatment, and a third of the homeless are mentally ill. Many are too discouraged or disorganized to take any initiative. Some will not agree to treatment because they are isolated and withdrawn, or paranoid and suspicious. Others refuse help because they wrongly believe they are doing well enough without it."

The article further notes that Court-ordered treatment for these people has been discussed for many years now as one part of a solution to this problem. This court-ordered treatment is known by various names in the community, including outpatient commitment, mandatory outpatient treatment, or assisted outpatient treatment. For more information - see our section on assisted treatment.

Perhaps most the most interesting aspect of this article from Harvard is its identification of the results of some key studies of the results of the outpatient treatment laws that have been enacted (most famously in New York - in the Kendra's Law case).

The Study Results.

The article states that:

The New York State Office of Mental Health issued a report on Kendra's Law in 2005 and pronounced it a success. From 1999 to 2004, nearly 4,000 court orders were issued, usually for six months, and in two-thirds of cases the orders were renewed. About 70% of the patients committed under the statute had schizophrenia and 13% had bipolar disorder. The report found that after commitment these patients were morelikely to take their medications and less likely to be homeless, arrested, or hospitalized. In interviews, nearly two-thirds of the patients said they thought that the court order had been good for them.

Also, in a trial conducted at Duke University,

"patients discharged from a psychiatric hospital were assigned at random to community treatment alone or to outpatient commitment with community treatment. The researchers found that after a year, patients assigned to outpatient commitment had a better quality of life because they were more likely to comply with treatment and less likely to be victims of violence."


In an independent analysis for the Cochrane Collaboration, reviewers in 2005 concluded that the only strong evidence for the value of outpatient commitment came from the findings of the Duke study on the risk of criminal victimization.

The article ends with a balanced statement saying that while outpatient commitment may be valuable, but that the availability of treatment is another very serious problem. Many people can't get treatment if they want it because of the poor state of US public mental health system. The new outpatient commitment laws may be a way to increase the incentive for better services. It may also be true the if better mental health services were made available to the public, the need for outpatient commitment laws would be lower.

Source: Harvard Mental Health Letter, March 1st, 2006


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