Research Network on Mandated Community Treatment
An intense policy debate is occurring in many countries on the legitimacy of laws ordering people with mental disorder to accept outpatient mental health treatment. Much of this debate on “outpatient commitment” assumes that court-ordered treatment in the community is simply an extension of long-existing policies authorizing involuntary commitment as a hospital inpatient. In fact, however, outpatient commitment is only one of a growing array of legal tools used to mandate adherence to mental health treatment in community settings.
People with severe and chronic mental disorders are often dependent upon goods and services provided by the social welfare system. Benefits disbursed by money managers and the provision of subsidized housing have both been used as leverage to assure treatment adherence in the community. Similarly, many people with mental disorder become involved with one or another aspect of the judicial system. For people who commit a criminal offense, adherence to mental health treatment may be made a condition of probation. Favorable disposition of their cases by a newly-created mental health court may also be tied to treatment participation. In addition, under some outpatient commitment statutes, judges have the authority to order committed patients to comply with prescribed treatment in the community, even if the patient does not meet the usual legal standards for treatment in a hospital.
In response, a patient may attempt to maximize his or her own control over treatment in the event of later deterioration by executing an advance directive that specifies treatment preferences or a proxy decision maker.
The Research Network on Mandated Community Treatment, funded by the John D. And Catherine T. MacArthur Foundation, seeks to elaborate a new and broader conceptual framework to encompass all forms of mandated treatment. To evaluate the role that mandated treatment may play in mental health law and policy, we are engaged in conducting new research on how frequently different types of leverage are used, how the process of applying leverage operates, and what the outcomes of leveraged treatment are–for the individual, for the mental health system, and for society. We are also sharpening our understanding of the profound legal, ethical, and political issues raised whenever leverage is used to secure treatment adherence. If mental health law and policy are to incorporate–or to repudiate–some or all of these types of leverage in the community, an evidence-based approach must become an integral part of these deliberations.
Other relevant Web sites on mandated community treatment:
John Monahan, Ph.D., Director