Should Psychiatric Treatment Be Mandated for Outpatients Who Are Severely Mentally Ill?

By Appelbaum, Paul S. | Clinical Psychiatry News, January 2004 | Go to article overview

Should Psychiatric Treatment Be Mandated for Outpatients Who Are Severely Mentally Ill?


Appelbaum, Paul S., Clinical Psychiatry News


YES

There is an appropriate role for mandating outpatient treatment for patients who have evidenced an inability to manage their own illness through repetitive decompensation and repeated hospitalizations.

Opponents of mandatory treatment say that if we only improved the mental health system to the point where the care being offered was attractive, there would not be a need to mandate treatment, because patients would come willingly.

But while that may be the case for some patients, it's not the reality for many patients with severe mental illnesses such as schizophrenia and bipolar disorder.

For many patients with these conditions, the denial both of their illness and of the need for treatment is part and parcel of the disorder.

Outpatient commitment statutes and mental health courts offer a formal way for mental health patients with a pattern of revolving door admissions to get treatment in the community. These mechanisms include strict due process requirements and representation for the patient.

There is no question that the current system for mandatory outpatient treatment--which varies from state to state--has flaws that limit its effectiveness.

The laws generally come without the resources necessary for effective implementation. In some states where the statutes are not adequately funded, they go largely unused. …

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