Hospital Utilization Outcomes Following Assignment to Outpatient Commitment

Abstract 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:	Artikel

Erscheinungsjahr:	2021
Erschienen:	2021

Enthalten in:	Zur Gesamtaufnahme - volume:48
Enthalten in:	Administration and policy in mental health and mental health services research - 48(2021), 6 vom: 03. Feb., Seite 942-961

Sprache:	Englisch

Beteiligte Personen:	Segal, Steven P. [VerfasserIn]

Links:	Volltext [lizenzpflichtig]

Themen:	Community treatment order Involuntary treatment Law and psychiatry Outpatient civil commitment

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

doi:	10.1007/s10488-021-01112-y

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PPN (Katalog-ID):	OLC2077140062