Outpatient commitment - AbsoluteAstronomy.com

Outpatient commitment refers to mental health law

Mental health law

Mental health law is the area of the law that applies to persons with a diagnosis or possible diagnosis of mental illness, and to those involved in managing or treating such people.-Mental health law in general:...

that allows the compulsory, community-based treatment of individuals with mental illness

Mental illness

A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...

.

In the United States the term "assisted outpatient treatment" or "AOT" is often used and refers to a process whereby a judge orders a qualifying person with symptoms of severe untreated mental illness to adhere to a mental health treatment plan while living in the community. The plan typically includes medication and may include other forms of treatment as well. In England the Mental Health Act 2007

Mental Health Act 2007

The Mental Act 2007 is an Act of the Parliament of the United Kingdom. It amends the Mental Health Act 1983 and the Mental Capacity Act 2005. It applies to people in England and Wales. Most of the Act was implemented on 3 November 2008....

introduced "Community Treatment Orders (CTOs)" . In Australia they are also called Community Treatment Orders and last for a maximum of twelve months but can be renewed after review by a tribunal. Criteria for outpatient commitment are established by law, which vary among nations and, in the U.S., from state to state. Some require court hearings and others require that treating psychiatrists comply with a set of requirements before compulsory treatment is instituted. When a court process is not required, there is usually a form of appeal to the courts or appeal to or scrutiny by tribunals set up for that purpose. Community treatment laws have generally followed the worldwide trend of community treatment

Psychiatric hospital

Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...

. See mental health law

Mental health law

for details of countries which do not have laws that regulate compulsory treatment.

History

Discussions of "outpatient commitment" began in the psychiatry community in the 1980s following deinstitutionalization, a trend that led to the widespread closure of public psychiatric hospitals and resulted in the discharge of large numbers of people with mental illness to the community. In the last decade of the 20th century and the first of the 21st, "outpatient commitment" laws were passed in a number of U.S. state

U.S. state

A U.S. state is any one of the 50 federated states of the United States of America that share sovereignty with the federal government. Because of this shared sovereignty, an American is a citizen both of the federal entity and of his or her state of domicile. Four states use the official title of...

s and jurisdictions in Canada

Canada

Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

. By the end of 2010, 44 U.S. states had enacted some version of an outpatient commitment law. In some cases, passage of the laws followed widely publicized "preventable tragedies, such as the murders of Laura Wilcox

Laura's Law

Laura's Law is a California state law that allows for court-ordered assisted outpatient treatment. To qualify for the program, the person must have a serious mental illness plus a recent history of psychiatric hospitalizations, jailings or acts, threats or attempts of serious violent behavior...

and Kendra Webdale

Kendra's Law

Kendra's Law, effective since November 1999, is a New York State law concerning involuntary outpatient commitment. It grants judges the authority to issue orders that require people who meet certain criteria to regularly undergo psychiatric treatment. Failure to comply could result in commitment...

.

A landmark report by the RAND Corporation was commissioned by the Senate Committee on Rules

United States Senate Committee on Rules and Administration

The Senate Committee on Rules and Administration is responsible for the rules of the United States Senate, with administration of congressional buildings, and with credentials and qualifications of members of the Senate, including responsibility for dealing with contested elections.The committee...

in 2001 when a bill authorizing court-ordered outpatient treatment was being debated in California (subsequently passed and known as "Laura's Law

Laura's Law

" for Laura Wilcox). This 176-page report was an evidence-based review that both searched the literature and interviewed key informants for their perceptions of the assisted outpatient treatment system. Among the findings:

There was widespread support for outpatient commitment among key informants, although quite a few expressed only qualified support for the practice in their own states.
Three things were deemed critical to the success of outpatient commitment: having the infrastructure to support it; having the services to make it work for patients; and having a service system that can deliver those services rationally.
Outpatient commitment laws were being used infrequently in most states and were used primarily as a discharge-planning vehicle rather than an alternative to hospitalization.
As part of their commitment process, at least three states were using mechanisms to involve the patient in development of a consensus plan for compliance with mental health treatment.
There was disagreement as to whether the outpatient commitment order is "reciprocal"(i.e., commits the provider or mental health system to provide services as well as committing the patient to receive them).
Provider liability was a concern but not an overwhelming one.
Not all outpatient commitment orders were specific about which agency will provide services and what the specific treatment will be. Medication was not necessarily a part of the commitment orders.
In most states, medication over objection was not allowed under outpatient commitment orders.
The burden of monitoring outpatient commitment orders most often fell to treatment providers, most of whom did not have the resources to provide high levels of supervision.
States differed widely in the extent to which their outpatient commitment orders had "teeth"(i.e., were enforceable).

In the literature review, Rand noted that the literature in 2001 was not of high methodological quality and that "while there may exist a subgroup of people with severe mental illness for whom a court order acts as leverage to enhance treatment compliance, the best studies suggest that the effectiveness of outpatient commitment is linked to the provision of intensive services. Whether court orders have any effect at all in the absence of intensive treatment is an unanswered question." However, more recent studies such as those from the New York Office of Mental Health (OMH) in 2005 and 2009 showed that outpatient treatment was effective.

These studies were also tended to refute criticissm from opponents of assisted outpatient treatment. The 2005 study found:

Specifically, the OMH study found that among participants in the AOT program:

74 percent fewer experienced homelessness;
77 percent fewer experienced psychiatric hospitalization;
83 percent fewer experienced arrest; and
87 percent fewer experienced incarceration.

Comparing the experience of outpatient commitment recipients over the first six months of commitment to the same period immediately prior to commitment, the OMH study found:

55 percent fewer recipients engaged in suicide attempts or physical harm to self;
49 percent fewer abused alcohol;
48 percent fewer abused drugs;
47 percent fewer physically harmed others;
46 percent fewer damaged or destroyed property; and
43 percent fewer threatened physical harm to others.

As a component of the OMH study, researchers with the New York State Psychiatric Institute and Columbia University conducted face-to-face interviews with 76 recipients to assess their opinions about the program and its impact on their quality of life. The interviews showed that after receiving treatment, assisted outpatient treatment recipients overwhelmingly endorsed the program:

75 percent reported that AOT helped them gain control over their lives;
81 percent said that AOT helped them to get and stay well; and
90 percent said AOT made them more likely to keep appointments and take medication.

Additionally, 87 percent of participants said they were confident in their case manager's ability to help them; 88 percent said that they and their case manager agreed on what is important for them to work on, i.e., assisted outpatient treatment exhibited a positive effect on the therapeutic alliance.

In 2009, an independent study by Duke University into alleged racism found "no evidence that the (assisted outpatient treatment) Program is disproportionately selecting African Americans for court orders, nor is there evidence of a disproportionate effect on other minority populations. Our interviews with key stakeholders across the state corroborate these findings."

Subsequent studies have confirmed a positive effect in outcomes, albeit attenuated from the NY OMH 2005 study. A 2010 study on Kendra's Law by Gilbert et al. showed that "the odds of arrest for participants currently receiving assisted outpatient treatment (AOT) were nearly 2/3 lower (OR .39, p<.01) than for individuals who had not yet initiated AOT or signed a voluntary service agreement." Another 2010 study from Swartz et al. tracked Medicaid claims and state reports for 3,576 AOT consumers from 1999-2007. They found that "the likelihood of psychiatric hospital admission was significantly reduced by ~25% during the initial six-month court order (odds ratio [OR]=.77, 95CI=.72-.82) and by over 1/3 during a subsequent six-month renewal of the order (OR=.59, CI=.54-.65) compared with the period before initiation of the court order. Similar significant reductions in days of hospitalization were evident during initial court orders and subsequent renewals (OR=.80, CI=.78-.82, & OR-.84, CI=.81-.86, respectively)."

Controversy

Proponents have argued that outpatient commitment improves mental health, increases the effectiveness of treatment, and reduces costs. Opponents of outpatient commitment laws argue that they unnecessarily limit freedom, force people to ingest dangerous medications, or are applied with racial and socioeconomic biases.

Proponents

While many outpatient commitment laws have been passed in response to violent acts committed by people with mental illness, most proponents involved in the outpatient commitment debate base their arguments on the quality of life and cost associated with untreated mental illness and "revolving door patients" who experience a cycle of hospitalization, treatment and stabilization, release, and decompensation. While the cost of repeated hospitalzations is indisputable, quality-of-life arguments rest on an understanding of mental illness as an undesirable and dangerous state of being. Outpatient commitment proponents point to studies performed in North Carolina

North Carolina

North Carolina is a state located in the southeastern United States. The state borders South Carolina and Georgia to the south, Tennessee to the west and Virginia to the north. North Carolina contains 100 counties. Its capital is Raleigh, and its largest city is Charlotte...

and New York

New York

New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...

that have found some positive impact of court-ordered outpatient treatment.

Opponents

Outpatient commitment opponents make several varied arguments. Some dispute the positive effects of compulsory treatment, questioning the methodology of studies that show effectiveness. Others highlight negative effects of treatment. Still others point to disparities in the way these laws are applied. The psychiatric survivors movement

Psychiatric survivors movement

The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services...

opposes compulsory treatment on the basis that the ordered drugs often have serious or unpleasant side-effects

Adverse effect

In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...

such as tardive dyskinesia

Tardive dyskinesia

Tardive dyskinesia is a difficult-to-treat form of dyskinesia that can be tardive...

, neuroleptic malignant syndrome

Neuroleptic malignant syndrome

Neuroleptic malignant syndrome is a life- threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs...

, excessive weight gain

Weight gain

Weight gain is an increase in body weight. This can be either an increase in muscle mass, fat deposits, or excess fluids such as water.-Description:...

leading to diabetes, addiction

Substance use disorder

Substance use disorders include substance abuse and substance dependence. In DSM-IV, the conditions are formally diagnosed as one or the other, but it has been proposed that DSM-5 combine the two into a single condition called "Substance-use disorder"....

, sexual

Human sexuality

Human sexuality is the awareness of gender differences, and the capacity to have erotic experiences and responses. Human sexuality can also be described as the way someone is sexually attracted to another person whether it is to opposite sexes , to the same sex , to either sexes , or not being...

side effects, and increased risk of suicide

Suicide

Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...

. The New York Civil Liberties Union

New York Civil Liberties Union

The New York Civil Liberties Union is an civil rights organization in the United States. Founded in 1951 as the New York affiliate of the American Civil Liberties Union, it is a not-for-profit, nonpartisan organization with nearly 50,000 members across New York State.NYCLU's stated mission is to...

has denounced what they see as racial and socioeconomic biases in the issuing of outpatient commitment orders.

External links

http://www.treatmentadvocacycenter.org - Treatment Advocacy Center
MindFreedom.org - MindFreedom
National Mental Health Consumers' Self-Help Clearinghouse
Civil commitment laws and standards by state - Civil commitment laws and standards by state
The Treatment Advocacy Center - 'Laura's Law'
The Treatment Advocacy Center - 'Kendra's Law'

The source of this article is wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL.

History

Controversy

Proponents

Opponents

See also

External links