Department of Sociomedical Sciences, Columbia University, 722 W. 168th St., 16th Floor, New York, NY 10032, USA.
Psychiatr Serv. 2010 Feb;61(2):137-43. doi: 10.1176/ps.2010.61.2.137.
Outpatient commitment has been heralded as a necessary intervention that improves psychiatric outcomes and quality of life, and it has been criticized on the grounds that effective treatment must be voluntary and that outpatient commitment has negative unintended consequences. Because few methodologically strong data exist, this study evaluated New York State's outpatient commitment program with the objective of augmenting the existing literature.
A total of 76 individuals recently mandated to outpatient commitment and 108 individuals (comparison group) recently discharged from psychiatric hospitals in the Bronx and Queens who were attending the same outpatient facilities as the group mandated to outpatient commitment were followed for one year and compared in regard to psychotic symptoms, suicide risk, serious violence perpetration, quality of life, illness-related social functioning, and perceived coercion and stigma. Propensity score matching and generalized estimating equations were used to achieve the strongest causal inference possible without an experimental design.
Serious violence perpetration and suicide risk were lower and illness-related social functioning was higher (p<.05 for all) in the outpatient commitment group than in the comparison group. Psychotic symptoms and quality of life did not differ significantly between the two groups. Potential unintended consequences were not evident: the outpatient commitment group reported marginally less (p<.10) stigma and coercion than the comparison group.
Outpatient commitment in New York State affects many lives; therefore, it is reassuring that negative consequences were not observed. Rather, people's lives seem modestly improved by outpatient commitment. However, because outpatient commitment included treatment and other enhancements, these findings should be interpreted in terms of the overall impact of outpatient commitment, not of legal coercion per se. As such, the results do not support the expansion of coercion in psychiatric treatment.
门诊承诺被认为是改善精神科结果和生活质量的必要干预措施，但也有人批评说，有效的治疗必须是自愿的，而门诊承诺会产生负面的意外后果。由于几乎没有强有力的方法学数据，本研究评估了纽约州的门诊承诺计划，旨在增加现有文献。
共随访了 76 名最近被强制门诊承诺的人和 108 名（对照组）最近从布朗克斯和皇后区精神病院出院的人，他们正在接受与被强制门诊承诺的人相同的门诊治疗。比较了这两组人在精神病症状、自杀风险、严重暴力行为、生活质量、与疾病相关的社会功能以及感知到的强制和污名方面的情况。使用倾向评分匹配和广义估计方程，在没有实验设计的情况下尽可能得出最强的因果推断。
门诊承诺组的严重暴力行为和自杀风险较低，与疾病相关的社会功能较高（所有 p<.05），而两组之间的精神病症状和生活质量没有显著差异。没有明显的意外后果：门诊承诺组报告的污名和强制感比对照组略低（p<.10）。
纽约州的门诊承诺影响了许多人的生活；因此，没有观察到负面后果是令人欣慰的。相反，门诊承诺似乎适度地改善了人们的生活。然而，由于门诊承诺包括治疗和其他增强措施，这些发现应该根据门诊承诺的整体影响来解释，而不是法律强制本身。因此，这些结果不支持在精神科治疗中扩大强制。
