The Effectiveness of Involuntary Outpatient Treatment: Empirical Evidence and the Experience of Eight States

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Involuntary commitment, Civil commitment, Community-based care, Program evaluation, Outcomes evaluation, Treatment


RAND Health --The RAND Institute for Civil Justice--RAND Health Board of Overseers --The RAND Institute for Civil Justice Board of Overseers --Preface --Summary. Approach--The Comparative Effectiveness of Involuntary Treatment and Its Alternatives--The Experience of Other States--The Effect of Proposed Changes in the Lanterman-Petris-Short Act on People with Mental Illness in California--What We Can and Cannot Say About the Policy Question--Acknowledgments --I. Introduction --II. Study Approach and Methods. Evidence-Based Review of the Literature on Involuntary Treatment--Statutory and Case Law Analysis--Key Informant Interviews--Analysis of California Data on Involuntary Treatment--III. What Does the Empirical Literature Tell Us About the Effectiveness of Involuntary Treatment? The Evolution of Involuntary Outpatient Commitment--Legal Criteria and Provisions for Involuntary Outpatient Commitment--Practices and Challenges in the Use of Outpatient Commitment--Effectiveness of Involuntary Outpatient Commitment--Research Challenges--First Generation Studies on the Effectiveness of Outpatient Commitment--Second Generation Studies on the Effectiveness of Outpatient Commitment--IV. What Does the Empirical Literature Tell Us About the Effectiveness of Alternatives? --V. How Have Other States Implemented Involuntary Outpatient Treatment? Michigan--New York--North Carolina--Ohio--Oregon--Texas--Washington--Wisconsin--VI. What Lessons Have Been Learned from the Experience of Other States? Outpatient Commitment: Support for the Law but Qualified Support for the Practice--The Treatment System Is Critical to the Success of Outpatient Commitment--Outpatient Commitment Is Used Infrequently and Primarily as a Discharge-Planning Vehicle--Making the Outpatient Commitment Process More "Voluntary"--Are Commitment Orders "Reciprocal": Who Is Committed Under an Outpatient Commitment Order -- the Patient, the Provider or Both?--The Issue of Provider Liability Doesn't Figure Prominently Among the List of Concerns People Have--The Specificity of Outpatient Commitment Orders -- Are Medications Included?--Most Key Informants Report That Forcible Medication Is Not Allowed--The Burden of Monitoring Falls Mostly on the Treatment System -- Which Has Implications for Treatment Resources--States Differ Widely in the Extent to Which Commitment Laws and Practices Have "Teeth"--Some States Are Already Looking for an Alternative Solution to the Problem of Noncompliance--Most Key Informants Report a Lack of Consistency Across Jurisdictions But Also Report That Little Is Being Done--"Closing Arguments"--Conclusion--VII. Involuntary Treatment in California: Who Is Potentially Affected by a Change in the Lanterman-Petris-Short Act? Involuntary Treatment Under the Lanterman-Petris-Short Act--Data on Civil Commitment in California--Describing the Population Subject to Current Commitment Guidelines--Profiling People in Involuntary Treatment in California in 1997-98--Service Use and Commitment History--Identifying Subcategories of At-Risk Individuals Under Expansions of LPS--Conclusion--VIII. Conclusion. The Comparative Effectiveness of Involuntary Treatment--The Experience of Other States--The Effect of LPS Changes on People with Mental Illness in California--References--Appendix A. Search Methodology--Screening Form--Abstraction Form-- Appendix B.Project Description--Project Team--Interview Protocol--List of Interview Respondents --Appendix C--Appendix D--Appendix E--Appendix F

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RAND Corporation, p. 176