A randomized controlled trial of outpatient commitment in North Carolina

Objective: A randomized controlled trial of outpatient commitment was condu cted in North Carolina to provide empirical data on involuntary outpatient commitment and to evaluate its effectiveness in improving outcomes among pe rsons with severe mental illnesses. Methods: A total of 331 involuntarily h ospitalized patients awaiting discharge under outpatient commitment were ra ndomly assigned to be released or to undergo outpatient commitment. Each re ceived case management services and outpatient treatment. Participants in b oth groups were monitored for one year. After the initial 90-day outpatient commitment order, a patient could receive a renewable 180-day extension. P atients in the control group were immune from outpatient commitment for one year. Information was obtained from self-reports and reports of several in formants as well as from outpatient treatment, hospital, and arrest records . Results: In most bivariate analyses, outcomes for the outpatient commitme nt group and the control group did not differ significantly when the durati on of outpatient commitment was not taken into account. However, patients w ho underwent sustained outpatient commitment and who received relatively in tensive outpatient treatment had fewer hospital admissions and fewer days i n the hospital, were more Likely to adhere to community treatment, and were less likely to be violent or to be victimized. Extended outpatient commitm ent was also associated with fewer arrests of participants with a combined history of multiple rehospitalizations and previous arrests. The interventi on was particularly effective among individuals with psychotic disorders. C onclusions: Outpatient commitment can improve treatment outcomes when the c ourt order is sustained and combined with relatively intensive community tr eatment. A court order alone cannot substitute for effective treatment in i mproving outcomes.