Involuntary Out-Patient Commitment and Reduction of Violent Behaviour in Persons with Severe Mental Illness
Digital Object Identifier (DOI)
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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Citation / Publisher Attribution
The British Journal of Psychiatry, v. 176, issue 4, p. 324-331
Scholar Commons Citation
Swanson, Jeffrey W.; Swartz, Marvin S.; Wagner, Ryan H.; Burns, Barbara J.; Borum, Randy; and Hiday, Virginia A., "Involuntary Out-Patient Commitment and Reduction of Violent Behaviour in Persons with Severe Mental Illness" (2000). Mental Health Law & Policy Faculty Publications. 19.