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Hospital Utilization Outcomes Following Assignment to Outpatient Commitment.

Steven P Segal^1,2

¹Department of Social Work, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia. spsegal@berkeley.edu.

Administration and Policy in Mental Health

|February 3, 2021

Summary

Outpatient civil commitment (OCC) can be effective for severe mental illness (SMI) treatment. Aggressive case management reduces hospitalizations, but limited community services increase them, showing varied outcomes.

Keywords:

Community treatment order Involuntary treatment Law and psychiatry Outpatient civil commitment

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Area of Science:

Public Health
Psychiatry
Health Services Research

Background:

Outpatient civil commitment (OCC) mandates treatment for severe mental illness (SMI) to prevent safety threats.
Community-based treatment is preferred as a less restrictive alternative (LRA) to hospitalization.
Variations in hospital use after OCC are often seen as treatment failure.

Purpose of the Study:

To identify factors influencing hospital utilization after OCC assignment.
To evaluate the effectiveness of OCC in providing necessary treatment and ensuring safety.

Main Methods:

A review of 25 studies, including seven meta-analyses and subsequent investigations, on post-OCC hospital utilization.
Studies were categorized by factors like deinstitutionalization, LRA availability, and illness severity.
Study quality was assessed using a causal certainty ranking system.

Main Results:

Deinstitutionalization without accounting for bed availability correlated with lower hospital use.
OCC combined with intensive case management reduced hospitalizations.
Insufficient community services led to increased hospitalizations as the default treatment option.
Some studies indicated less hospitalization during OCC supervision compared to periods outside it.

Conclusions:

Hospital utilization outcomes under OCC vary significantly based on mental health system structures and service availability.
Effective OCC implementation, particularly with robust case management and community support, can reduce hospitalizations.
Even with varied utilization, OCC fulfills its legal mandate to provide essential treatment and ensure patient safety.