The effectiveness and ethical justification of psychiatric outpatient commitment.
Studies link involuntary outpatient commitment with improved patient outcomes, fueling debate on its ethical justification. This study compares inpatient utilization for committed outpatients in the 1990s with those who were not under outpatient civil commitment orders. Findings reveal committed outpatients had higher utilization of inpatient services and restraint episodes prior to their commitment compared with a control group. Committed outpatients also were more likely to have been on discharge status at the time of admission, have been admitted involuntarily under emergency legal procedures, and have had a greater number of admissions and hospital days prior to their commitment. Following commitment, patients had fewer hospitalizations, shorter lengths of stay, fewer seclusion episodes and hours, and fewer restraint episodes and hours. Findings are discussed within the context of parens patriae and therapeutic jurisprudence, and support medical and public policy justifications for ethical uses of outpatient civil commitment laws for seriously mentally ill patients.
Zanni
Guido R
GR
New York State Department of Health Albany Law School, Alden March Institute of Albany Medical College, USA.
Stavis
Paul F
PF
D000377:Agnosia; D026688:Bioethical Issues; D016009:Chi-Square Distribution; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D003617:Dangerous Behavior; D004219:District of Columbia / Q000453:epidemiology; D026690:Ethics, Clinical; D019317:Evidence-Based Medicine; D006760:Hospitalization / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D010045:Outpatients / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D026706:Paternalism / Q000941:ethics; D010342:Patient Acceptance of Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D028701:Patient Rights; D019726:Patient Self-Determination Act; D011570:Psychiatry / Q000941:ethics* / Q000331:legislation & jurisprudence / Q000379:methods*; D011640:Public Policy; D012149:Restraint, Physical / Q000706:statistics & numerical data; D012647:Self-Assessment; D016896:Treatment Outcome; D014481:United States