Torrey E F, Kaplan R J
National Institute of Mental Health Neuroscience Center, St. Elizabeths Hospital, Washington, D.C. 20032, USA.
Psychiatr Serv. 1995 Aug;46(8):778-84. doi: 10.1176/ps.46.8.778.
To determine the extent of use of outpatient commitment, a survey was undertaken of each state and the District of Columbia.
One of the authors, an attorney, reviewed pertinent state statutes, then conducted telephone interviews with individuals in each state who were knowledgeable about the use of outpatient commitment.
Thirty-five states and the District of Columbia have laws permitting outpatient commitment. Georgia, Hawaii, and North Carolina use different criteria for outpatient commitment than for inpatient commitment. In only 12 states and the District of Columbia was use of outpatient commitment rated as very common or common. Reasons for not using it include concerns about civil liberties, liability, and fiscal burden as well as lack of information and interest, the failure of some states to set enforceable consequences for noncompliance, and criteria that are too restrictive. Some states use alternative formal or informal mechanisms to encourage treatment compliance; conditional release is widely used in New Hampshire and conservatorship-guardianship in California. Within many states the availability of outpatient commitment varies considerably by locale.
To clarify the role of outpatient commitment in psychiatric services, more research is needed to identify optimal candidates for its use. Research is also needed on its overall effectiveness compared with conditional release and conservatorship-guardianship and on the consequences of not using such mechanisms to improve treatment compliance.
为确定门诊强制治疗的使用范围，对每个州及哥伦比亚特区进行了一项调查。
作者之一，一名律师，查阅了相关州法规，然后对每个州了解门诊强制治疗使用情况的人员进行了电话访谈。
35个州及哥伦比亚特区有允许门诊强制治疗的法律。佐治亚州、夏威夷州和北卡罗来纳州对门诊强制治疗采用的标准与住院强制治疗不同。只有12个州及哥伦比亚特区将门诊强制治疗的使用评为非常普遍或普遍。不使用门诊强制治疗的原因包括对公民自由、责任和财政负担的担忧，以及信息和兴趣的缺乏、一些州未对不遵守规定设定可执行的后果，以及标准过于严格。一些州使用替代的正式或非正式机制来鼓励治疗依从性；新罕布什尔州广泛使用有条件释放，加利福尼亚州使用监护-保护制度。在许多州内，门诊强制治疗的可获得性因地区而异。
为阐明门诊强制治疗在精神科服务中的作用，需要更多研究来确定其最佳适用对象。还需要研究其与有条件释放和监护-保护制度相比的总体有效性，以及不使用此类机制改善治疗依从性的后果。
