Involuntary Out-Patient Commitment and Reduction of Violent Behaviour in Persons with Severe Mental Illness

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Background: Violent behaviour among persons with severe mental illness (SMI) causes public concern and is associated with illness relapse, hospital recidivism and poor outcomes in community-based treatment.

Aims: To test whether involuntary out-patient commitment (OPC) may help to reduce the incidence of violence among persons with SMI.

Method: One-year randomised trial of the effectiveness of OPC in 262 subjects with psychotic or major mood disorders and a history of hospital recidivism. Involuntarily hospitalised subjects awaiting OPC were randomly assigned to release or court-ordered treatment after discharge. Those with a recent history of serious assault remained under OPC until expiry of the court order (up to 90 days); then OPC orders were renewed at clinical/court discretion. Control subjects had no OPC. Four-monthly follow-up interviews with subject, case manager and collateral informant took place and service records were collected.

Results: A significantly lower incidence of violent behaviour occurred in subjects with ≥6 months' OPC. Lowest risk of violence was associated with extended OPC combined with regular out-patient services, adherence to prescribed medications and no substance misuse.

Conclusions: OPC may significantly reduce risk of violent behaviour in persons with SMI, in part by improving adherence to medications while diminishing substance misuse.

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The British Journal of Psychiatry, v. 176, issue 4, p. 324-331