Brown Jonathan D
Johns Hopkins University School of Public Health, Department of Mental Hygiene, 624 N. Broadway, Room 384, Baltimore, MD 21205, USA.
Ethical Hum Sci Serv. 2003 Spring;5(1):7-20.
Involuntary outpatient commitment (IOC) statutes exist in response to disorganized community mental health service delivery and perceived treatment non-compliance. These statutes attempt to force psychiatric patients to comply with outpatient mental health services. Mental health service consumers, providers, and advocates have increasingly questioned the necessity and legality of IOC. Credible research indicates that IOC does not substantially benefit consumers and may increase mental health deterioration. IOC has proven difficult to implement, enforce, and successfully measure. Rather than resorting to expanding coercive measures, mental health systems and policymakers must ensure provision of voluntary and accessible mental health services. Furthermore, IOC cannot be legally or ethically justified even if hypothetical research supporting its alleged effectiveness exists. This article summarizes influential and contradictory IOC research, explores legal issues, and proposes that providing voluntary consumer-driven services would reduce IOC usage and prevent criminalizing individuals experiencing serious emotional distress.
非自愿门诊治疗（IOC）法规的存在是为了应对社区精神卫生服务提供的混乱以及被认为的治疗不依从情况。这些法规试图迫使精神病患者接受门诊精神卫生服务。精神卫生服务消费者、提供者和倡导者越来越质疑非自愿门诊治疗的必要性和合法性。可靠的研究表明，非自愿门诊治疗对消费者没有实质性益处，可能会加剧精神健康恶化。事实证明，非自愿门诊治疗难以实施、执行和成功衡量。精神卫生系统和政策制定者不应诉诸扩大强制性措施，而必须确保提供自愿且可及的精神卫生服务。此外，即使存在支持其所谓有效性的假设性研究，非自愿门诊治疗在法律和伦理上也无法得到正当理由。本文总结了有影响力且相互矛盾的非自愿门诊治疗研究，探讨了法律问题，并提出提供由消费者驱动的自愿服务将减少非自愿门诊治疗的使用，并防止将经历严重情绪困扰的个人定罪。
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