the state’s authority to act preventively in certain cir-
cumstances. For example, in upholding the constitu-
tionality of New York’s outpatient commitment statute,
the New York Court of Appeals observed that the
statute forwarded the state’s interest in “warding off
the longer periods of hospitalization that, as the
Legislature has found, tend to accompany relapse or
deterioration” (In the Matter of K.L., 2004, p. 487).Issues in Implementing
Outpatient Commitment
The implementation of outpatient commitment statutes
varies by state. A number of implementation issues
have been reported. First, it appears that regardless of
the type of statutory provision a state has, outpatient
commitment orders are used most frequently at the
point of discharge, as a way of attempting to ensure
treatment compliance as the person enters the commu-
nity. Second, there are a number of practical barriers
that sometimes reduce the use of outpatient commit-
ment. These include difficulties in transporting the
individual, limits on treatment capacity, and lack of
adequate social supports such as housing. Third, per-
ceived difficulties in enforcing outpatient commitment
orders may reduce its use in some situations.The Impact of Outpatient
Commitment Statutes
There have been two generations of research into the
effectiveness of outpatient commitment statutes. The
first generation of research generally relied on anec-
dotal evidence from a particular state or jurisdiction,
and while this research often suggested that outpatient
commitment was effective, there were significant
methodological problems that called the reliability
and generalizability of the findings into question.
The second generation of research has been more
methodologically rigorous and has examined the
impact of pure outpatient commitment statutes, prin-
cipally in New York and North Carolina. The most
comprehensive studies have been conducted in NorthCarolina. The North Carolina studies relied on ran-
dom assignment of involuntarily hospitalized individ-
uals meeting the state’s criteria for outpatient
commitment to either be released from treatment or
undergo outpatient commitment. Patients in the latter
group could receive a renewable 180-day treatment
extension after the original 90 days of treatment.
While outcomes between the two groups did not dif-
fer significantly on most measures, patients in the lat-
ter group who received comparatively more intensive
outpatient commitment over a longer time had fewer
hospital admissions, had fewer days in hospital, were
less likely to be violent or victimized, and were more
likely to comply with outpatient treatment. However,
a comparably designed study in New York did not find
similar outcomes.
While it is not clear from the extant research pre-
cisely how outpatient commitment might result in bet-
ter outcomes for some individuals, the North Carolina
studies in particular suggest that outpatient commit-
ment orders must be accompanied by treatment over
time to be effective.John PetrilaSee alsoCivil Commitment; Patient’s RightsFurther Readings
In the Matter of K.L.,806 N.E.2d 480 (N.Y. 2004).
Monahan, J., Swartz, M. S., & Bonnie, R. (2003). Mandated
treatment in the community for people with mental
disorders. Health Affairs, 22,28–38.
Ridgely, S., Borum, R., & Petrila, J. (2002). The effectiveness
of outpatient commitment. Santa Monica, CA: RAND
Institute.
Swartz, M. S., Swanson, J. W., Hiday, V.A., Wagner, H. R.,
Burns, B. J., & Borum, R. (2001). A randomized
controlled trial of outpatient commitment in North
Carolina. Psychiatric Services, 52,325–329.
Swartz, M. S., Swanson, J. W., Kim, M., & Petrila, J. (2006).
Use of outpatient commitment or related civil court
treatment orders in five U.S. communities. Psychiatric
Services, 57,343–349.534 ———Outpatient Commitment, InvoluntaryO-Cutler (Encyc)-45463.qxd 11/18/2007 12:43 PM Page 534