The Effectiveness and Ethical Justification of Psychiatric Outpatient Commitment

Abstract

Studies link involuntary outpatient commitment with improved patient outcomes, fueling debate on its ethical justification. This study compares inpatient utilization for committed outpatients in the 1990s with those who were not under outpatient civil commitment orders. Findings reveal committed outpatients had higher utilization of inpatient services and restraint episodes prior to their commitment compared with a control group. Committed outpatients also were more likely to have been on discharge status at the time of admission, have been admitted involuntarily under emergency legal procedures, and have had a greater number of admissions and hospital days prior to their commitment. Following commitment, patients had fewer hospitalizations, shorter lengths of stay, fewer seclusion episodes and hours, and fewer restraint episodes and hours. Findings are discussed within the context of parens patriae and therapeutic jurisprudence, and support medical and public policy justifications for ethical uses of outpatient civil commitment laws for seriously mentally ill patients.

Tratamiento ambulatorio involuntario en psiquiatría: una revisión desde la bioética

“…Cabe destacar que no son muy numerosos y presentan dificultades metodológicas. Así, encontramos una primera generación de estudios observacionales y una segunda generación, aún menos numerosa donde se compara, mediante un reparto aleatorio a pacientes con TAI frente a un grupo control (17,18,19,20,21,22,23,24,25,26,27,28).…”

“…♦ Las enfermedades mentales son crónicas y las interrupciones del tratamiento son una de las causas de recaídas. Los abandonos repetidos de tratamiento originan el fenómeno de "puerta giratoria" que hace que los pacientes sufran repetidos ingresos involuntarios por descompensaciones de una misma enfermedad (21,35).…”

Locked inpatient units in modern mental health care: values and practice issues

“…This is an application of the principle of parens patriae (“father of the people”), in that the state intervenes in the manner of a parent to protect the best interests of the patient. Such intervention, when prompt and efficacious, may serve to reduce further occasions of involuntary treatment and therefore has the (beneficent) effect of a net increase in liberty;25 by being associated with reduced absconding and reduced overall risk, locking a unit may similarly be viewed as beneficent.…”

Coercion or Caring: The Fundamental Paradox for Adherence Interventions for HIV+ People with Mental Illness

“…Advances in psychotropic pharmaceuticals in the 1950s in conjunction with a well-organized advocacy effort in the 1960’s provided the impetus for the historical shift to deinstitutionalization during the 1970s (9–11). It has been argued that deinstitutionalization led to the advent of compulsory community-based treatment (12–13) which engendered its own negative history as rights of people with severe mental illness conflicted with concern for their mental health and wellbeing (14).…”