Mandated community treatment: Beyond outpatient commitment

Outpatient commitment, although often viewed as merely an extension of inpa tient commitment, is only one of a growing array of legal tools used to man date treatment adherence. The authors describe various forms of mandated co mmunity treatment. People with severe and chronic mental disorders often de pend on goods and services provided by the social welfare system. Benefits disbursed by representative payees and the provision of subsidized housing have both been used as leverage to ensure treatment adherence. Many dischar ged patients are arrested for criminal offenses. Favorable disposition of t heir cases by a mental health court may be tied to participation in treatme nt. Under outpatient commitment statutes, judges can order committed patien ts to comply with prescribed treatment. Patients may attempt to maximize th eir control over treatment in the event of later deterioration by executing an advance directive. The ideological posturing that currently characteriz es the field must be replaced by an evidence-based approach.