Effectiveness and outcomes of assisted outpatient treatment in New York State.
OBJECTIVE
Outpatient commitment has been heralded as a necessary intervention that improves psychiatric outcomes and quality of life, and it has been criticized on the grounds that effective treatment must be voluntary and that outpatient commitment has negative unintended consequences. Because few methodologically strong data exist, this study evaluated New York State's outpatient commitment program with the objective of augmenting the existing literature.


METHODS
A total of 76 individuals recently mandated to outpatient commitment and 108 individuals (comparison group) recently discharged from psychiatric hospitals in the Bronx and Queens who were attending the same outpatient facilities as the group mandated to outpatient commitment were followed for one year and compared in regard to psychotic symptoms, suicide risk, serious violence perpetration, quality of life, illness-related social functioning, and perceived coercion and stigma. Propensity score matching and generalized estimating equations were used to achieve the strongest causal inference possible without an experimental design.


RESULTS
Serious violence perpetration and suicide risk were lower and illness-related social functioning was higher (p<.05 for all) in the outpatient commitment group than in the comparison group. Psychotic symptoms and quality of life did not differ significantly between the two groups. Potential unintended consequences were not evident: the outpatient commitment group reported marginally less (p<.10) stigma and coercion than the comparison group.


CONCLUSIONS
Outpatient commitment in New York State affects many lives; therefore, it is reassuring that negative consequences were not observed. Rather, people's lives seem modestly improved by outpatient commitment. However, because outpatient commitment included treatment and other enhancements, these findings should be interpreted in terms of the overall impact of outpatient commitment, not of legal coercion per se. As such, the results do not support the expansion of coercion in psychiatric treatment.
Phelan
Jo C
JC
Department of Sociomedical Sciences, Columbia University, 722 W. 168th St., 16th Floor, New York, NY 10032, USA. jcp13@columbia.edu
Sinkewicz
Marilyn
M
Castille
Dorothy M
DM
Huz
Steven
S
Muenzenmaier
Kristina
K
Link
Bruce G
BG
D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019090:Case Management; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders; D003155:Community Mental Health Centers; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D009518:New York; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D017060:Patient Satisfaction; D011287:Prejudice; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life / Q000523:psychology; D012917:Social Adjustment; D013405:Suicide / Q000523:psychology; D014505:Urban Population; D014754:Violence / Q000517:prevention & control / Q000523:psychology; D000092864:Suicide Prevention