Involuntary Outpatient Commitment: A Naturalistic Study of Its Use and a Consumer Survey at One Community Mental Health Center in Israel

Abstract

The following study assessed the efficacy of involuntary outpatient commitment in promoting treatment adherence and preventing hospitalization during and after a period of compulsory treatment in one community mental health center in Israel and evaluated the attitudes of patients and psychiatrists. All patients referred for involuntary outpatient commitment over a two year period (N = 26) were followed up for 3-5 years. After the termination of the commitment, the patient and psychiatrist were interviewed. Although only three patients had been in regular outpatient treatment before the commitment, fourteen remained in regular care during the commitment's duration and ten remained for a further two years. Comparing the follow-up period with the identical duration before the commitment, the number of hospitalizations and number of days hospitalized were significantly reduced. Fifteen were rehospitalized during follow-up. Thirteen patients were interviewed at the termination of the commitment, and nearly all perceived the commitment in negative terms, although eight did not think it had a negative effect on their relationship with the psychiatrist and six thought their opinions were respected. Six of the psychiatrists considered they were not giving optimum treatment. Despite the presence of the commitment, psychiatrists were often sensitive to patients' wishes and the involuntary aspect of the care was often not pursued. While half of the sample were lost to community care, half remained for several years. The study reflects the delicate nature of involuntary care in the community, so that in practice it is often not involuntary, not for outpatients and not a commitment.