EFFECTIVENESS OF INVOLUNTARY OUTPATIENT COMMITMENT

不遵守治疗仍然是复发的主要原因， 再住院、功能下降和其他不良结局 严重的精神疾病。努力查明其原因和补救办法 违规行为引发了广泛的临床调查 努力。减少违规行为的一个有希望的方法是法院- 强制门诊治疗称为非自愿门诊 承诺(OPC)。所有的州都有门诊的规定 承诺相信OPC将改善依从性和治疗 结果。在实践中，OPC可以作为动员资源的刺激因素 以进行更积极的治疗。一些研究表明， 证明了OPC降低了再住院率并改善了其他 结果；但结果好坏参半，部分原因是服务的可变性 条文。还没有研究检查OPC影响的程度 基本服务始终如一的依从性和治疗结果 也没有对选择效应和其他方面的研究进行控制 重要的混淆。这项拟议的研究考察了OPC对 服务系统动员中的依从性和治疗结果净额 OPC联合社区病例的随机临床试验 管理层，并将寻求消除以往研究中的偏见来源 OPC的。非自愿入院的患者符合严重和 持续性精神疾病和OPC的法律标准将是随机的 被分配到两种治疗条件之一：OPC加病例管理或 单单是病例管理。这两个组将包括类似比例的 黑人和农村患者。主要关注的结果是： 再次住院和住院时间，以及再次住院之前的时间。 其他结果包括精神症状、功能、生活质量， 家庭负担、危险、逮捕和监禁。除 心理健康的具体计划公告、有效性和结果 农村精神卫生服务的服务与研究：本研究 阐述公共-学术联系倡议的计划优先事项 并对服务系统的法律问题科作出答复 为NIMH国家研究计划开发的研究小组报告 改善对严重精神疾病的护理。

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.