EFFECTIVENESS OF INVOLUNTARY OUTPATIENT COMMITMENT

这一竞争性的延续扩展了杜克精神健康研究，这是第一个关于非自愿门诊承诺(OPC)在减少严重精神疾病(SMI)患者再住院和改善结果方面的有效性的随机对照试验(RCT)。OPC是一种有希望但有争议的法律干预措施，旨在惠及SMI患者，他们需要持续的精神护理和支持以防止危险的复发和再次犯罪，但他们需要持续的精神护理和支持以防止危险的复发和再次犯罪，但他们不愿或难以寻求和贯彻以社区为基础的治疗。38个州和哥伦比亚特区都有明确的OPC法规。尽管如此，关于OPC的优点和缺点的关键信息仍然缺乏，它如何发挥作用，持续多长时间，以及针对哪些临床亚组。社区中法院命令治疗的强制方面是否值得SMI消费者、照顾他们的人以及整个社会获得潜在好处？在最近完成的随机对照研究中，等待门诊门诊的非自愿住院患者被随机分配到出院后继续接受门诊治疗，或从法院命令中解脱出来，接受自愿病例管理服务。对一年随访数据的分析表明，接受持续门诊治疗和频繁门诊服务的受试者显著减少了住院和暴力行为。然而，我们还没有(并提议)检查其他关键结果(症状、功能、药物滥用、无家可归、被捕、家庭/照顾者压力)，以及关键的中间变量(治疗强度、服药依从性)。还必须审查OPC的基础机制以及OPC后的长期结果。为了制定OPC实践指南，还需要对利益相关者对这一有争议的干预的效用进行评估。这一竞争性延续申请的目标是解决NIMH国家咨询精神卫生委员会的临床治疗和服务工作组报告中概述的优先事项。“架起科学与服务的桥梁”我们建议：(1)通过完成正在进行的RCT分析来扩展关于OPC有效性的现有研究；(2)收集关于消费者和其他利益相关者对OPC的偏好和态度的数据；(3)为负责制定OPC实践指南的专家共识小组综合所有关于OPC有效性和效用的现有证据；以及(4)评估指南实施和设计实践改进研究的策略。

This competing continuation extends the Duke Mental Health Study the first randomized controlled trial (RCT) of the effectiveness of involuntary outpatient commitment (OPC) in reducing rehospitalization and improving outcomes among persons with severe mental illnesses (SMI). OPC is a promising, but controversial legal intervention designed to benefit SMI individuals who need ongoing psychiatric care and support to prevent dangerous relapse and recidivism, but who are SMI individuals who need ongoing psychiatric care and support to prevent dangerous relapse and recidivism, but who are reluctant or have difficulty seeking and following through with community-based treatment. Thirty-eight states and the District of Columbia have explicit OPC statutes. Still, key information is lacking on the advantages and drawbacks of OPC how it exerts its effects, for how long, and for which clinical subgroups. Are the coercive aspects of court-ordered treatment in the community worth the potential benefits to SMI consumers, those who care for them, and to society in general? In the RCT recently completed, involuntarily hospitalized patients awaiting OPC were randomly assigned to continue under OPC upon discharge, or be released from their court order and receive voluntary case management services. Analyses of one-year follow-up data demonstrate that subjects who received sustained periods of OPC and frequent outpatient services had significantly reduced hospitalizations and violent behavior. However, we have yet to (and propose to) examine other key outcomes (symptoms, functioning, substance abuse, homelessness, arrests, family/caregiver strain), and key intervening variables (treatment intensity, medication adherence). Mechanisms underlying OPC must also be examined as well as long-term outcomes post-OPC. Assessment of stakeholders' utilities for this controversial intervention is also needed in order to develop OPC practice guidelines. The goal of this competing continuation application is to address the priorities outlined in the NIMH National Advisory Mental Health Council's Clinical Treatment and Services Workgroup Report. "Bridging Science and Service." We propose to: (1) Extend existing research on OPC's effectiveness by completing ongoing RCT analyses; (2) Gather data about consumers' and other stakeholders' preferences and attitudes regarding OPC; (3) Synthesize all available evidence on OPC effectiveness and utilities for an expert consensus panel charged with developing OPC practice guidelines; and (4) Assess strategies for guideline implementation and design practice improvement research.