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Outpatient commitment (OPC) is a less restrictive alternative to the involuntary hospitalization of mentally ill patients who are ordered by the courts to seek treatment. It is based on the philosophy that while a mentally ill person may be determined dangerous and need treatment, he may not need inpatient care. Inpatient care has been the usual treatment, and often the only choice for those committed. In theory, OPC provides all the components of inpatient commitment, yet affords greater freedom. It is also an answer to the 'revolving door syndrome', which has resulted from shortened hospital stays. The revolving door syndrome refers to the fact that many chronically mentally ill patients are released after a short stay in the hospital, only to relapse and be readmitted due to noncompliance with aftercare. OPC, by providing mandatory outpatient care and monitoring, may help to eliminate this problem for many people. Ninety-seven patients hospitalized pending civil commitment hearings were followed for six months after they were released, mandated to OPC, or involuntarily hospitalized. About 54 percent were male and 94 percent were under 60 years old. Seventy-eight percent were diagnosed as schizophrenic and 58 percent had more than two prior hospitalizations. About half had a history of at least three episodes of dangerous behavior. Thirty-one were referred to OPC, the rest were either hospitalized involuntarily or released with the recommendation that they seek outpatient care. Those attending OPC were significantly more likely to attend outpatient care after discharge from the hospital than those who were not; they were also less likely to be noncompliant. Most remained in treatment after the end of the six-month study period, despite the fact that their mandate had expired three months earlier. The two who left treatment were rehospitalized by the sixth month. Based on these results, outpatient commitment is an effective tool by which to encourage compliance with all aspects of mental health care and treatment maintenance. This can effectively reduce the tendency for patients to get caught in the revolving door syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Involuntary outpatient commitment (OPC) is a promising but controversial legal intervention that may reduce criminal justice contact in persons with severe mental illness (SMD. This article examines arrest outcomes in a 1-year randomized study of OPC in 262 participants with SMI in North Carolina. Extended OPC was found to be significantly associated with reduced arrest probability (12% vs. 45%) in a subgroup with a prior history of multiple hospitalizations combined with prior arrests and/or violent behavior. Reduction in risk of violent behavior was a significant mediating factor in the association between OPC and arrest. In persons with SMI whose history of arrests is related directly to illness relapse, OPC may reduce criminal justice contact by increasing participation in mental health services.