Interpreting the Effectiveness of Involuntary Outpatient Commitment: A Conceptual Model
Swanson, Jeffrey W.
Swartz, Marvin S.
George, Linda K.
Burns, Barbara J.
Hiday, Virginia A.
Wagner, H. Ryan
Journal of the American Academy of Psychiatry and the Law. 1997; 25(1): 5-16.
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 usefully interpreting what happens inside the experimental "black box." This paper describes a conceptual model of involuntary outpatient commitment (OPC) for persons with severe and persistent mental disorders. The model represents an attempt to "unpack" the effects of OPC by incorporating several interacting variables at various stages. According to this model, court-mandated outpatient treatment may improve long-term outcomes both directly and indirectly in several ways: by stimulating case management efforts, mobilizing supportive resources, improving individual compliance with treatment in the community, reducing clients' psychiatric symptoms and dangerous behavior, improving clients' social functioning, and finally by reducing the chance of illness relapse and rehospitalization. A randomized clinical trial of OPC is underway in North Carolina that will test the direct and indirect effects suggested by this model, using longitudinal data from the multiple perspectives of mental health clients, family members, and case managers.
Autonomy; Coercion; Community Services; Case Management; Duration of Commitment; Empirical Research; Evaluation; Family Members; Health; Health Care; Health Care Delivery; Involuntary Commitment; Illness; Mental Disorders; Mental Health; Mental Institutions; Minority Groups; Managers; Outpatient Commitment; Paternalism; Patient Admission; Patient Compliance; Rehabilitation; Research; Theoretical Models;
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Swanson, Jeffery W.; Swartz, Marvin S.; George, Linda K.; Burns, Barbara J.; Hiday, Virginia A.; Borum, Randy; Wagner, H. Ryan (1997)