INTERPRETING THE EFFECTIVENESS OF INVOLUNTARY OUTPATIENT COMMITMENT -A CONCEPTUAL-MODEL

Many experimental trials of community mental health interventions fail to develop testable conceptual models of the specific mechanisms and pathways by which relevant outcomes may occur, thus falling short of u sefully interpreting what happens inside the experimental ''black box. '' This paper describes a conceptual model of involuntary outpatient c ommitment (OPC) for persons with severe and persistent mental disorder s. The model represents an attempt to ''unpack'' the effects of OPC by incorporating Several interacting variables at various stages. Accord ing to this model, court-mandated outpatient treatment may improve lon gterm outcomes both directly and indirectly in several ways: by stimul ating case management efforts, mobilizing supportive resources, improv ing individual compliance with treatment in the community, reducing cl ients' psychiatric symptoms and dangerous behavior, improving clients' social functioning, and finally by reducing the chance of illness rel apse and rehospitalization. A randomized clinical trial of OPC is unde rway in North Carolina that will test the direct and indirect effects suggested by this model, using longitudinal data from the multiple per spectives of mental health clients, family members, and case managers.