Extended outpatient civil commitment and treatment utilization.
OBJECTIVE
This study considers four hypotheses regarding the impact of extended involuntary outpatient commitment orders on services utilization.


METHODS
All Victorian Psychiatric Case Register (VPCR) patients who had extended (180+ day) outpatient commitment orders in the nine year study period and a matched treatment compliant comparison group with extended periods of outpatient care (N = 1182), both with at least two years of post-episode experience, were evaluated. Pre/post episode utilization was compared via paired t tests with individuals as their own controls. Logistic and OLS regression as well as repeated measures ANOVA via the GLM SPSS program and post hoc t tests were used to evaluate between group and across time differences.


RESULTS
Extended episodes of care for both groups were associated with reduced use of hospitalization and increases in outpatient services. Extended orders did not promote voluntary participation in the post-period. Outpatient services during the extended episode for those on orders were raised to the level experienced by the treatment compliant comparison group and maintained at that level via subsequent renewal of orders throughout the patients' careers. OLS regression results indicate that approximately six community care service days were required for those on orders to achieve a one-day reduction in hospital utilization following the extended episode.


CONCLUSIONS
Outpatient commitment for those on extended orders in the Victorian context enables a level of community-based services provision, unexpected in the absence of this delivery system, which provides an alternative to hospitalization.
Segal
Steven P
SP
Mental Health and Social Welfare Research Group, School of Social Welfare, 120 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA.
Burgess
Philip
P
D000328:Adult; D000341:Affective Disorders, Psychotic / Q000628:therapy*; D000359:Aftercare / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D003156:Community Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D017050:Episode of Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012042:Registries; D012559:Schizophrenia / Q000628:therapy*; D014600:Utilization Review / Q000706:statistics & numerical data; D014739:Victoria