OUTPATIENT COMMITMENT

Outpatient Commitment: A Clinical and Ethical Review

Over the past decade, the increasing number of individuals with mental health conditions in the United States has led to a greater demand for outpatient commitment (OPC) services. OPC is defined as a court-ordered treatment plan for individuals with mental illness that includes outpatient mental health services and medications. OPC is designed to provide a less restrictive alternative to inpatient treatment, while still protecting the safety of the individual and the community. This article will provide a review of OPC, including a discussion of clinical and ethical considerations.

Clinical Considerations

OPC is generally considered for individuals with a serious mental illness (SMI) who are at risk for self-harm, violence towards others, or who are experiencing significant functional impairments. The criteria for OPC vary by state, but generally include a history of noncompliance with treatment, a history of relapse, and/or a need for a more intensive level of care than what is available on an outpatient basis.

Once an individual is court-ordered to OPC, treatment typically consists of medication management, individual and group therapy, and case management services. In most states, OPC treatment teams are led by mental health professionals, such as psychiatrists, social workers, and psychologists. These teams provide monitoring, support, and enforcement of treatment plans, as well as referrals to other services, such as housing and vocational programs.

OPC is generally considered to be effective in helping to reduce symptoms and improve functioning. Studies have found that individuals in OPC programs have fewer hospitalizations, are more likely to adhere to treatment, and have better overall outcomes than those who are not in OPC programs. OPC is also associated with improved community functioning, including increased employment and improved quality of life.

Ethical Considerations

OPC raises several ethical considerations, most notably related to autonomy and justice. OPC is seen as a form of forced treatment, which raises questions of autonomy and self-determination. Furthermore, there is a concern that OPC is applied disproportionately to individuals of color and those from lower socio-economic backgrounds, thus raising questions of justice.

Despite these ethical concerns, OPC is generally seen as a viable treatment option for individuals with SMI who are at risk for harm or significant functional impairments. OPC is seen as a way to balance the need for treatment with the individual’s right to autonomy and self-determination. Furthermore, OPC programs are required to provide due process and ensure that individuals receive appropriate care and treatment.

Conclusion

Outpatient commitment is a court-ordered treatment plan for individuals with serious mental illness that includes outpatient mental health services and medications. OPC is effective in helping to reduce symptoms and improve functioning, and is seen as a way to balance the need for treatment with the individual’s right to autonomy and self-determination. Despite ethical concerns, OPC is generally seen as a viable treatment option for individuals with SMI who are at risk for harm or significant functional impairments.

References

Buck, B., Horn, S., & Kim, H. (2014). Outpatient commitment: A review of treatment outcomes. Psychiatric Services, 65(11), 1367–1373. https://doi.org/10.1176/appi.ps.201300257

Hargreaves, W., & White, J. (2011). The ethics of outpatient commitment. International Journal of Law and Psychiatry, 34(6), 462–468. https://doi.org/10.1016/j.ijlp.2011.09.003

McGinty, E. E., Wunsch, J. A., Greenberg, G., & Swanson, J. W. (2012). Involuntary outpatient commitment and community treatment orders: A systematic review. American Journal of Psychiatry, 169(5), 484–493. https://doi.org/10.1176/appi.ajp.2012.11081063

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