Can involuntary outpatient commitment reduce hospital recidivism?: Findings from a randomized trial with severely mentally ill individuals.
OBJECTIVE
The goal of this study was to evaluate the effectiveness of involuntary outpatient commitment in reducing rehospitalizations among individuals with severe mental illnesses.


METHODS
Subjects who were hospitalized involuntarily were randomly assigned to be released (N = 135) or to continue under outpatient commitment (N = 129) after hospital discharge and followed for 1 year. Each subject received case management services plus additional outpatient treatment. Outpatient treatment and hospital use data were collected.


RESULTS
In bivariate analyses, the control and outpatient commitment groups did not differ significantly in hospital outcomes. However, subjects who underwent sustained periods of outpatient commitment beyond that of the initial court order had approximately 57% fewer readmissions and 20 fewer hospital days than control subjects. Sustained outpatient commitment was shown to be particularly effective for individuals with nonaffective psychotic disorders, reducing hospital readmissions approximately 72% and requiring 28 fewer hospital days. In repeated measures multivariable analyses, the outpatient commitment group had significantly better hospital outcomes, even without considering the total length of court-ordered outpatient commitments. However, in subsequent repeated measures analyses examining the role of outpatient treatment among psychotically disordered individuals, it was also found that sustained outpatient commitment reduced hospital readmissions only when combined with a higher intensity of outpatient treatment.


CONCLUSIONS
Outpatient commitment can work to reduce hospital readmissions and total hospital days when court orders are sustained and combined with intensive treatment, particularly for individuals with psychotic disorders. This use of outpatient commitment is not a substitute for intensive treatment; it requires a substantial commitment of treatment resources to be effective.
Swartz
M S
MS
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. swart001@mc.duke.edu
Swanson
J W
JW
Wagner
H R
HR
Burns
B J
BJ
Hiday
V A
VA
Borum
R
R
D000328:Adult; D000553:Ambulatory Care; D019090:Case Management; D003134:Commitment of Persons with Psychiatric Disorders / Q000592:standards*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D015999:Multivariate Analysis; D010351:Patient Discharge; D010359:Patient Readmission; D011618:Psychotic Disorders / Q000517:prevention & control / Q000523:psychology / Q000628:therapy; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016896:Treatment Outcome