Involuntary Outpatient Commitment in Florida: Case Information and Provider Experience and Opinions

Abstract

The use of involuntary outpatient commitment (IOC) is a significant international issue. Variations can be found in Australia, New Zealand, Scotland, Ontario (Canada), Switzerland, and the United States. Its use varies considerably by country and in the United States, between states. In Florida, the IOC statute has been used sparingly. This paper first presents information about the first fifty IOC cases in Florida including a description of the pre-and post-IOC order emergency commitments and state hospital admissions of these individuals. It then provides results from a survey of mental health professionals about their experience with and opinions about IOC. The majority of the individuals with IOC orders had at least one emergency commitment in the two years pre-IOC order (n = 46; range 1-7) and in the two years post-IOC order (n = 41; range 1-13). While 41 individuals experienced 68 total emergency commitments in the 180 days prior to the IOC order, 18 individuals had 24 emergency commitments in the 180 days after the order. Eleven had at least one state hospital admission pre-IOC order, with eight having such an admission post-IOC order. Results from the survey suggest that a number of issues have reduced the use of IOC, including difficulties in applying the statute, inadequate clinical resources, and skepticism regarding the practical effect of an IOC order on positive clinical outcomes. The implications of these results for policy development are discussed.

The Cost of Assisted Outpatient Treatment: Can It Save States Money?

“…Forty-five states now permit outpatient commitment in some form, yet the practice has been implemented only sporadically, if at all (20). Several factors may explain the low penetration of assisted outpatient treatment (7,(21)(22)(23). Vocal mental health consumer advocates oppose it, and some mental health clinicians and administrators raise liability and operational concerns.…”

State Laws on Emergency Holds for Mental Health Stabilization

“…Ideally, a patient placed on an emergency hold is discharged with a long-term care strategy. Unfortunately, many patients on emergency holds are discharged without a mental health care strategy or lack the resources to follow through on the plan advised and find themselves in a cycle of crisis care (20). Emergency hold laws do not require the implementation of a long-term treatment strategy, and, remarkably, Alabama, Arkansas, Colorado, and Utah do not mandate that a person on an emergency hold be seen by a health care professional at all.…”

Care planning for consumers on community treatment orders: an integrative literature review

“…Several studies highlighted the lack of usefulness of CTOs to those clients whereby coercion experienced from being on the CTO cancelled out any gains [35, 36] with clinicians reporting consumers most likely to benefit from a CTO being those with a level of insight into their mental health problems, and therefore more likely to collaborate with services [36, 37]. Consumers needed to accept the validity of a treatment order for CTOs to be a viable treatment option [37, 38] with Mullen et al [39] suggesting that if good therapeutic relationships were not achieved within a reasonable period of time they should be discharged from the CTO to voluntary care.…”

“…Consumers needed to accept the validity of a treatment order for CTOs to be a viable treatment option [37, 38] with Mullen et al [39] suggesting that if good therapeutic relationships were not achieved within a reasonable period of time they should be discharged from the CTO to voluntary care.…”

“…These broader service issues were referred to in several of the included papers. Limited resources and service availability were reported to impact on decisions around CTO use as well as result in increased use of CTOs to facilitate early discharge from inpatient services [31, 37, 48] and access to limited inpatient beds [29, 31]. Psychiatrists reported high caseloads, insufficient time available to spend with consumers and reduced service options in rural areas [7].…”