Outpatient Civil Commitment and Mental

Outpatient Civil Commitment and Mental Illness

Should the courts force individuals with mental illness to take medication in the form of outpatient civil commitment?

Should the Courts Force Individuals with Mental Illness to Take

Medication in the Form of Outpatient Civil Commitment?

Outpatient commitment is a court order that requires a person with severe psychiatric illness such as schizophrenia and bipolar disorder to participate in mental health treatment such as intensive outpatient programs and medications management (Torrey & Zdanowicz, 2001). Failure to follow the terms of the court order can result in sanctions such as involuntary hospitalization. The goal of this proposed intervention is to reduce the likelihood that an individual with a severe psychiatric illness will become victimized or engage in activities that place themselves or the community at risk. This intervention should also ensure that effective services are made available to these individuals and that services are delivered in an effective manner (RAND Corporation, 2000).

Should the Courts Force Individuals with Mental Illness to Take Medication in the Form of Outpatient Civil Commitment?

Studies have been conducted on the effectiveness of involuntary outpatient commitment for persons with severe psychiatric illness. The goal of the outpatient commitment is to guarantee that services are delivered to a significantly at risk population as well ensuring societal well-being (RAND Corporation, 2000). The overall lack of consistent empirical data makes it difficult to clearly determine the effectiveness of this proposed court ordered intervention (RAND Corporation, 2000). However, there does appear to be significant literature supporting the involuntary treatment and medication of persons with severe psychiatric illness when they are unable to make the decision for themselves due to a lack of awareness of the impact of their illness on their lives (Torrey & Zdanowicz, 2001).

Outpatient commitment is a civil commitment that orders an individual with mental illness to participate in a treatment regimen that may include outpatient therapy, intensive case management, medication management, etc. And carries the risk of imposable sanctions for noncompliance (Torrey & Zdanowicz, 2001). Proponents of this intervention method claim that it promotes adherence to treatment and reduces the potential for at-risk outcomes, such as incarceration, violence, suicide, and homelessness for this vulnerable population (Torrey & Zdanowicz, 2001). Torrey and Zdanowicz proposed that such treatments are categorized as medically necessary and should be ordered only in situations where it is in the best interest of the individual and society.

Persons with severe mental illnesses such as schizophrenia and bipolar disorder, at times, are unable to recognize the significant risk that their illness poses to themselves and others without proper treatment (Torrey & Zdanowicz, 2001). This lack of awareness may leave them at risk of victimization and increases the possibility of negative outcomes such as relapse, inpatient hospitalization, homelessness, violence, and suicide (Torrey & Zdanowicz, 2001).

Outpatient commitment should be implemented only in those cases where the risk for victimization or negative outcomes such as violence outweighs the individual's civil right to choose their treatment. Due to the potential restrictiveness of this intervention, with sanctions up to and including involuntary hospitalization, all less restrictive interventions and voluntary interventions should be exhausted. Torrey and Zdanowicz identify options such as advance directives where a person with a severe mental illness can authorize treatment for themselves at a future date and assertive case management that should be simultaneously explored to ensure the least restrictive outcome and treatment method.

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 treatments or refusal of treatment (Whitaker, 2002). 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).