title: Mandated community treatment: beyond outpatient commitment.
abstract: Outpatient commitment, although often viewed as merely an extension of inpatient commitment, is only one of a growing array of legal tools used to mandate treatment adherence. The authors describe various forms of mandated community treatment. People with severe and chronic mental disorders often depend on goods and services provided by the social welfare system. Benefits disbursed by representative payees and the provision of subsidized housing have both been used as leverage to ensure treatment adherence. Many discharged patients are arrested for criminal offenses. Favorable disposition of their cases by a mental health court may be tied to participation in treatment. Under outpatient commitment statutes, judges can order committed patients to comply with prescribed treatment. Patients may attempt to maximize their control over treatment in the event of later deterioration by executing an advance directive. The ideological posturing that currently characterizes the field must be replaced by an evidence-based approach.
authors.affiliation: University of Virginia School of Law, Charlottesville 22903-1789, USA. jmonahan@virginia.edu
authors.forename: J
authors.initials: J
authors.lastname: Monahan
authors.forename: R J
authors.initials: RJ
authors.lastname: Bonnie
authors.forename: P S
authors.initials: PS
authors.lastname: Appelbaum
authors.forename: P S
authors.initials: PS
authors.lastname: Hyde
authors.forename: H J
authors.initials: HJ
authors.lastname: Steadman
authors.forename: M S
authors.initials: MS
authors.lastname: Swartz
mesh_terms: D016223:Advance Directives; D000553:Ambulatory Care / Q000458:organization & administration*; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D003156:Community Mental Health Services / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D006801:Humans; D009042:Motivation; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011632:Public Assistance; D014481:United States