Talk:Outpatient commitment

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It shows Alaska not having an AOT law, but ALASKA STAT. § 47.30.755(b) provides indirectly for AOT. I don't do graphics; can someone update the image? — Preceding unsigned comment added by 24.61.41.34 (talk) 00:31, 3 January 2016 (UTC)[reply]

I'll do this at the same time that I update the map of Canada (see discussion below). It looks like Connecticut, Maryland, Massachusetts, & Tennessee are currently the only states without outpatient commitment laws.[1] —Shelley V. Adams ‹blame
credit› 03:18, 6 October 2017 (UTC)[reply]

Added mention of 1990's, 2000's "outpatient commitment" laws and events behind them.

Daniel C. Boyer

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Added mention of side-effects of neuroleptics.

Daniel C. Boyer

Daniel, this information should go on the Edit summary instead of in this discussion.--201.201.1.162 (talk) 23:00, 14 March 2010 (UTC)[reply]

A landmark report by the RAND Corporation ^[1] was commissioned by the Senate Committee on Rules in 2001 when a bill authorizing court-ordered outpatient treatment was being debated in California (subsequently passed and known as "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^[2] and 2009 ^[3] 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."^[4] 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)."^[5]

The above was removed as this is an article about outpatient commitment and not only Kendra's Law per WP:DUE. The findings of this study are not in line with the Cochrane Review of the efficacy of this treatment modality - which can be taken as the gold standard under WP:MEDRS. Some items may be readded into the history or controversy sections after the section on efficacy has been completed.FiachraByrne (talk) 17:57, 21 November 2012 (UTC)[reply]

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In November 2017, New Brunswick will be implementing "Community support orders". [2] and the map of Canada will need to be updated.--Auric talk 15:44, 25 August 2017 (UTC)[reply]

@Auric: I can update the map, but I'd like to add a caption and citation when I do so. Do you know where I can find a full list of which provinces and territories have (or lack) outpatient commitment laws? —Shelley V. Adams ‹blame
credit› 03:12, 6 October 2017 (UTC)[reply]

I'm afraid not. Sorry.--Auric talk 13:21, 6 October 2017 (UTC)[reply]

This article relies heavily on primary sources and others that don't meet the requirements for reliable medical sources. So, I've located several recent review articles and one meta-analysis about outpatient commitment that I intend to use to improve the article. Since there's no way I'll get to all of these tonight, I'm posting the list here (1) so I won't lose the citations and (2) in case anyone else would like to help.

All of these are free to access and published within the last 5 years. The articles from Actas Españolas de Psiquiatría, Canadian Journal of Psychiatry, and Frontiers in Public Health should also be useful for globalizing the article. —Shelley V. Adams ‹blame
credit› 02:35, 6 October 2017 (UTC)[reply]

@Hploter: Hey Hploter, I think it's quite valuable having information for Italy and France. Did you happen to have citations for these countries at hand, since you seem knowledgeable about this? I find cites very valuable when digging into a topic using wikipedia as a starting point Talpedia (talk) 17:49, 4 February 2022 (UTC)[reply]

One of these days I'm planning to take the blanking hammer to these primary sources from the US supporting outpatient commitment and replace them with similar reviews and recent larger studies that, if my reading is correct, suggest that they don't make any difference.... Talpedia (talk) 22:49, 19 August 2022 (UTC)[reply]