Jw. Swanson et al., Involuntary out-patient commitment and reduction of violent behaviour in persons with severe mental illness, BR J PSYCHI, 176, 2000, pp. 324-331
Background Violent behaviour among persons with severe mental illness (SMI)
causes public concern and is associated with illness relapse, hospital rec
idivism and poor outcomes in community-based treatment.
Aims To test whether involuntary outpatient commitment (OPC) may help to re
duce the incidence of violence among persons with SMI.
Method One-year randomised trial of the effectiveness of OPC in 262 subject
s with psychotic or major mood disorders and a history of hospital recidivi
sm. Involuntarily hospitalised subjects awaiting OPC were randomly assigned
to release or court-ordered treatment after discharge. Those with a recent
history of serious assault remained under OPC until expiry of the court or
der (up to 90 days); then OPC orders were renewed at clinical/court discret
ion. Control subjects had no OPC. Four-monthly follow-up interviews with su
bject, case manager and collateral informant-took place and service records
were collected.
Results A significantly lower incidence of violent behaviour occurred in su
bjects with greater than or equal to 36 months' OPC. Lowest risk of violenc
e was associated with extended OPC combined with regular out-patient servic
es, adherence to prescribed medications and no substance misuse.
Conclusions OPC may significantly reduce risk of violent behaviour in perso
ns with SMI, in part by improving adherence to medications while diminishin
g substance misuse.
Declaration of interest Funded by the National institute of Mental Health.