Mandated Community Treatment in Services for Persons with Mental Illness

This chapter addresses a complex and persistent challenge for mental health services delivery: What to do about adult members of our communities who suffer from debilitating psychiatric illnesses such as schizophrenia but fail to receive consistent and effective treatment. Many are gravely disabled and/or pose a danger to themselves or others, but are often unable or unwilling to adhere to recommended treatment until they deteriorate to the point of requiring involuntary hospitalization or are arrested for a minor crime. Involuntary outpatient commitment—often termed ‘assisted outpatient treatment’—was developed as one potential remedy to address this population of ‘revolving door’ patients. In this civil court procedure, a judge orders a person with mental illness to comply with recommended treatment. We discuss involuntary outpatient commitment in the broader context of mandated community treatment, review the controversies about its effectiveness, the ethics of its use and discuss some potential alternative approaches. Mandated community treatment, if properly targeted and implemented with sufficient resources, can offer a less-restrictive alternative to hospitalization or arrest with the goal of ensuring that beneficial treatment is consistently maintained, rather than delaying intervention until confinement is required.