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

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

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

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

Synopsis

In the last decade, many states have amended or interpreted their existing civil commitment statutes to allow for involuntary outpatient treatment. At the request of the California State Senate, the authors conducted a systematic literature review on inv

Excerpt

Involuntary treatment has been the most consistently debated issue in mental health law for the last thirty years. The goals of involuntary treatment have not changed radically overtime: insuring public safety, guaranteeing access to treatment for those who need it, and insuring that treatment is provided in the least restrictive environment consistent with the needs of the individual. In the last decade, however, the focus on involuntary treatment has changed as states have amended or interpreted their existing involuntary commitment statutes to allow for involuntary outpatient treatment and other mechanisms designed to extend the state's supervisory control over mentally ill persons into the community. This change in focus has served to intensify the controversy.

The most recent debate on involuntary treatment in California arose in response to the introduction of Assembly Bill 1800. AB 1800, introduced by Assemblywoman Helen Thomson and passed by the California Assembly last year, would have amended California's Lanterman-Petris-Short Act by expanding the criteria for involuntary treatment and creating a separate statutory provision for involuntary outpatient treatment.

After passage of AB 1800 in the Assembly, the Senate Committee on Rules commissioned RAND to develop a report on involuntary treatment. The project had three objectives: (1) to identify and synthesize the existing empirical evidence on the effectiveness of involuntary outpatient treatment and its alternatives; (2) to gather and analyze information on the experience of a select group of states where involuntary outpatient treatment is currently practiced; and (3) to assess the potential impact of such legislation on people with severe mental illness in California. This report summarizes our approach, findings, and conclusions.

We had five primary audiences in mind when conducting this research and reporting our findings: the Senate sponsors of this report; other public policymakers at the state and national level; researchers; clinicians; and advocates of all points of view. Members of all five audiences will find something of interest here. We have no doubt that those who advocate for and against involuntary outpatient treatment will use our report to support very different positions. Our task is to set out the evidence so the debate can be an informed one. It is up to others to advocate, armed with an understanding of what is known from empirical work and what remains to be known.

This report is based on research conducted under the auspices of RAND's Law and Health Initiative, which is a joint initiative of RAND Institute for Civil Justice and RAND Health. RAND ICJ's mission is to make civil justice systems more efficient and more equitable through objective, empirically-based research. RAND Health furthers RAND's mission of helping improve policy and decisionmaking through research and analysis by working to improve health care systems.

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