EFFECTIVENESS OF INVOLUNTARY OUTPATIENT COMMITMENT

非自愿门诊承诺的有效性

• 批准号: 2631844
• 负责人: MARVIN S SWARTZ
• 金额: $ 10万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1992
• 资助国家: 美国
• 起止时间: 1992-06-01 至 1999-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2631844
• 关键词: African American; behavioral /social science research tag; clinical trials; community mental health services; family; functional ability; health care model; health care service evaluation; health care service utilization; health related legal; hospital length of stay; hospital utilization; human subject; human therapy evaluation; interview; mental disorder diagnosis; mental health facility; outpatient care; patient care management; posthospitalization care; psychological tests; psychosis; quality of life; rural area; social support network; substance abuse related disorder; therapy compliance; violence

Non-compliance with treatment continues to be a major cause of relapse, rehospitalization, decreased functioning and other poor outcomes among the seriously mentally ill. Efforts to identify causes of and remedies for non-compliance have stimulated a wide range of clinical investigative efforts. One promising approach to reducing non-compliance is court- mandated outpatient treatment referred to as involuntary outpatient commitment (OPC). All states have made provisions for outpatient commitment in the belief that OPC will improve compliance and treatment outcomes. In practice, OPC may serve as a stimulus to mobilize resources for more aggressive treatment efforts. A number of studies have demonstrated that OPC reduces rates of rehospitalization and improves other outcomes; but findings are mixed, due in part to variability in service provision. No studies have examined the extent to which OPC affects compliance and treatment outcomes when essential services are consistently measured nor have studies controlled for selection effects and other important confounds. The proposed study examines the effects of OPC on compliance and treatment outcomes net of service system mobilization in a randomized clinical trial of OPC combined with community-based case management and will seek to eliminate previous sources of bias in studies of OPC. Involuntarily admitted patients meeting criteria for severe and persistent mental illness and legal criteria for OPC will be randomly assigned to one of two treatment conditions: OPC plus case management or case management alone. Both groups will include similar proportions of black and rural patients. Outcomes of primary interest are: rehospitalization and length of stay, and time until rehospitalization. Other outcomes include psychiatric symptoms, functioning, quality of life, family burden, dangerousness, arrests and jail time. In addition to the specific program announcements, Effectiveness and Outcomes of Mental Health Services and Research on Mental Health Services in Rural Areas, this study addresses the program priorities of the Public-Academic Liaison Initiative and is responsive to the Legal Issues Section of the Service Systems Research Panel Report developed for the NIMH National Plan of Research to Improve Care for Severe Mental Disorders.

不遵守治疗仍然是复发的主要原因，