Hospital Utilization Outcomes Following Assignment to Outpatient Commitment

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature..

Outpatient civil commitment (OCC) requires people with severe mental illness (SMI) to receive needed-treatment addressing imminent-threats to health and safety. When available, such treatment is required to be provided in the community as a less restrictive alternative (LRA) to psychiatric-hospitalization. Variance in hospital-utilization outcomes following OCC-assignment has been interpreted as OCC-failure. This review seeks to specify factors accounting for this outcome-variation and to determine whether OCC is used effectively. Twenty-five studies, sited in seven meta-analyses and subsequently published investigations, assessing post-OCC-assignment hospital utilization outcomes were reviewed. Studies were grouped by structural pre-determinants of hospital-utilization and OCC-implementation-i.e. deinstitutionalization (bed-availability), availability of a less restrictive alternative to hospitalization, and illness severity. Design quality at study completion was ranked on causal-certainty. In OCC-follow-up-studies, deinstitutionalization associated hospital-bed-cuts, when not taken into account, ensured lower hospital-bed-day utilization. OCC-assignment coupled with aggressive case-management was associated with reduced-hospitalization. With limited community-service, hospitalizations increased as the default option for providing needed-treatment. Follow-up studies showed less hospitalization while on OCC-assignment and more outside of it. Studies using fixed-follow-up periods usually found increased-utilization as patients spent less time under OCC-supervision than outside it. Comparison-group-studies reporting no between-group differences bring more severely ill OCC-patients to equivalent use as less disturbed patients, a success. Mean evidence-rank for causal-certainty 2.96, range 2-4, of 5 with no study ranked 1, the highest rank. Diverse mental health systems yield diverse OCC hospital-utilization outcomes, each fulfilling the law's legal mandate to provide needed-treatment protecting health and safety.

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:48

Enthalten in:

Administration and policy in mental health - 48(2021), 6 vom: 03. Nov., Seite 942-961

Sprache:

Englisch

Beteiligte Personen:

Segal, Steven P [VerfasserIn]

Links:

Volltext

Themen:

Community treatment order
Involuntary treatment
Journal Article
Law and psychiatry
Outpatient civil commitment
Research Support, N.I.H., Extramural
Review

Anmerkungen:

Date Completed 24.11.2021

Date Revised 20.09.2023

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1007/s10488-021-01112-y

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM320949060