A randomized controlled trial of outpatient commitment in North Carolina.
OBJECTIVE
A randomized controlled trial of outpatient commitment was conducted in North Carolina to provide empirical data on involuntary outpatient commitment and to evaluate its effectiveness in improving outcomes among persons with severe mental illnesses.


METHODS
A total of 331 involuntarily hospitalized patients awaiting discharge under outpatient commitment were randomly assigned to be released or to undergo outpatient commitment. Each received case management services and outpatient treatment. Participants in both groups were monitored for one year. After the initial 90-day outpatient commitment order, a patient could receive a renewable 180-day extension. Patients in the control group were immune from outpatient commitment for one year. Information was obtained from self-reports and reports of several informants as well as from outpatient treatment, hospital, and arrest records.


RESULTS
In most bivariate analyses, outcomes for the outpatient commitment group and the control group did not differ significantly when the duration of outpatient commitment was not taken into account. However, patients who underwent sustained outpatient commitment and who received relatively intensive outpatient treatment had fewer hospital admissions and fewer days in the hospital, were more likely to adhere to community treatment, and were less likely to be violent or to be victimized. Extended outpatient commitment was also associated with fewer arrests of participants with a combined history of multiple rehospitalizations and previous arrests. The intervention was particularly effective among individuals with psychotic disorders.


CONCLUSIONS
Outpatient commitment can improve treatment outcomes when the court order is sustained and combined with relatively intensive community treatment. A court order alone cannot substitute for effective treatment in improving outcomes.
Department of Psychiatry and Behavioral Sciences at Duke University Medical Center, Durham, North Carolina 27710, USA. swart001@mc.duke.edu
M S
MS
Swartz
J W
JW
Swanson
V A
VA
Hiday
H R
HR
Wagner
B J
BJ
Burns
R
R
Borum
D019090:Case Management; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence; D003156:Community Mental Health Services / Q000331:legislation & jurisprudence; D003415:Crime / Q000706:statistics & numerical data; D019548:Crime Victims; D003688:Deinstitutionalization; D006801:Humans; D019964:Mood Disorders / Q000188:drug therapy*; D009657:North Carolina; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010349:Patient Compliance; D010359:Patient Readmission / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000188:drug therapy*; D014754:Violence / Q000706:statistics & numerical data