Torrey and Zdanowicz (2001) identify some important aspects of outpatient commitment that would need to be present in order to ensure positive outcomes such as clear legal principles, a clear need-for-treatment standard (p. 340), available legal counsel for individuals with mental illness, and systematic processes for reviews and appeals. When determining the criteria by which a person should be deemed appropriate for outpatient commitment there should be considerable attention paid to their propensity for violence or victimization (Torrey & Zdanowicz, 2001). It should not be based upon an individual's non-dangerous behaviors such as substance abuse, relapse rate, or repeated hospitalizations.

Outpatient commitment must be coupled with a strong service delivery system that has readily available, appropriate services. It should be viewed as a commitment not just of the individual with mental illness to participate in services but of the system as a whole to ensure availability of service providers and ongoing effective service delivery. Court systems should develop an infrastructure to handle petitions in a respectful and non-threatening manner in order to prevent the trauma that can be associated with court proceedings. Further, a system of accountability should be implemented that not only addresses the individual's level of compliance but also that of the service delivery system. There should be regular reviews of the effectiveness of the services that the individual is compelled to participate in and service plans should be developed that are living documents, regularly changed to meet the needs of the individual.

Despite the compelling arguments for the outpatient commitment of those who lack the awareness to appreciate the risk that their illness poses to them, it should not be utilized on those whom can make rational decisions regarding their desired...

If an individual can make rational decisions about his or her illness then the system should respect these decisions and should never attempt to utilize outpatient commitment to coerce a more socially accepted outcome. In those instances where the wishes of the individual conflict with what would be deemed best practice, stakeholders should work with the individual to identify resources that address the illness in a respectful manner (Whitaker, 2002).
It is unclear from the literature whether a court order is truly the catalyst for the increased compliance with treatment regimens or if it is the availability of specific intensive services provided to an individual who has been identified as being at risk (RAND Corporation, 2000). It may simply be the identification of at-risk-individuals with psychiatric illness and the provision of intensive, targeted services that produces results. However, without evidence to suggest that these services alone could produce a significant decrease in negative outcomes the introduction of such an intervention is not contraindicated and should be explored. In any situation where outpatient commitment is considered one must always consider the wishes of the individual and weigh this against their level of risk to themselves and others.

References

RAND Corporation (2000). Does involuntary outpatient treatment work? Retrieved from:

http://www.rand.org/pubs/research_briefs/RB4537/index1.html

Torrey, E.F., & Zdanowicz, M. (2001). Outpatient commitment: What, why, and for whom.

Psychiatric Services, 52, 337-341.

Whitaker, R. (2002, June 9). Forced medication is inhumane. Should the mentally ill be allowed to refuse to take their medication? Boston Globe. Retrieved from http://www.freedom-center.org/pdf/whitaker_force.pdf