Outpatient commitment
The individual may be subject to rapid recall to hospital, including medication over objections, if the conditions of the order are broken, and the person's mental health deteriorates.
The criteria and process for outpatient commitment are established by law, which vary among nations and, in the U.S. and Canada, among states or provinces.
[10] Denmark introduced outpatient commitment in 2010 with the Mental Health Act (Danish: Lov om anvendelse af tvang i psykiatrien).
[15] As of 2014,[update] Dutch law provides for community treatment orders, and an individual who does not comply with the terms of their CTO may be subject to immediate involuntary commitment.
[13] When Norway introduced outpatient commitment in the 1961 Mental Health Act, it could only be mandated for individuals who had previously been admitted for inpatient treatment.
[16]: 62 Changes in service provision and amendments to the Mental Health Act in England and Wales have increased the scope for compulsion in the community.
[5] CTOs are legally defined as a form of outpatient leave for individuals detained under section 3 of the Mental Health Act.
However, the Royal College of Psychiatrists suggested limiting CTOs to patients with a history of noncompliance and hospitalization, when it reviewed the current mental health legislation.
This discharge would be reviewed yearly, and only apply to individuals who would not benefit from treatment in a hospital setting and would be based on risk.
[24] Scotland has a different community commitment regime from England and Wales introduced in the 2003 Mental Health Act.
Patients may be recalled if they don't abide to conditions on residence or medical supervision decided by a psychiatrist on discharge for 3 months after having been released from an involuntary commitment.
[3] In the Australian state of Victoria, community treatment orders last for a maximum of twelve months[29] but can be renewed after review by a tribunal.
[citation needed] Proponents have argued that outpatient commitment improves mental health, increases the effectiveness of treatment, lowers incidence of homelessness, arrest, incarceration and hospitalization and reduces costs.
Opponents of outpatient commitment laws argue that they unnecessarily limit freedom, force people to ingest dangerous medications, impede on their human rights, or are applied with racial and socioeconomic biases.
While the cost of repeated hospitalizations is indisputable, quality-of-life arguments rest on an understanding of mental illness as an undesirable and dangerous state of being.
Proponents include: Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Justice, Agency for Healthcare Research and Quality (AHRQ), U.
SAMHSA included Assisted Outpatient Treatment in their National Registry of Evidence Based Program and Practices.
[35][non-primary source needed] About $125 million is also spent annually on improved outpatient treatment for patients who are not subject to the law.
"[30] The National Institute of Justice considers assisted outpatient treatment an effective crime prevention program.
Analysis of data from case manager reports showed similar reductions in hospital admissions and improved engagement in services.
Writing in the British Journal of Psychiatry in 2013, Jorun Rugkåsa and John Dawson stated, "The current evidence from RCTs suggests that CTOs do not reduce readmission rates over 12 months.
Community awareness of AOT has resulted in increased outreach to individuals who had previously presented engagement challenges to mental health service providers.
Processes and structures developed for AOT have resulted in improvements to treatment plans that more appropriately match the needs of individuals who have had difficulties using mental health services in the past.
As AOT processes have matured, professionals from the two systems have improved their working relationships, resulting in greater efficiencies, and ultimately, the conservation of judicial, clinical, and administrative resources.
This was in spite of the fact that psychotropic drug costs increased during the first year after initiation of assisted outpatient treatment, by 40% and 44% in the city and five-county samples, respectively.
"[42][failed verification] "When the court order was for seven months or more, improved medication possession rates and reduced hospitalization outcomes were sustained even when the former AOT recipients were no longer receiving intensive case coordination services.
Other argue for a right of self-determination or self ownership, considering it a paternalistic approach that can be wrongly applied considering psychiatry criteria for diagnosis are very subjective backed by some studies questioning diagnosis (see Rosenhan experiment), the unlimited duration with often lack or no foresight to an end from the patient is also criticised.
[citation needed] Opponents claim they are giving medication to the patient, but there are no brain chemical imbalances to correct in "mental illness".
[60][61][62] The psychiatric survivors movement opposes compulsory treatment on the basis that the ordered drugs often have serious or unpleasant side-effects such as tardive dyskinesia, neuroleptic malignant syndrome, akathisia, excessive weight gain leading to diabetes, addiction, sexual side effects, increased risk of suicide and QT prolongation.
The New York Civil Liberties Union has denounced what they see as racial and socioeconomic biases in the issuing of outpatient commitment orders.
