This paper addresses the issue of violent behavior among persons with severe mental illness, which causes public concern and is associated with illness relapse, hospital recidivism, and poor outcomes in community-based treatment; they describe their research methodology, results, and clinical implications.
The authors of this paper report on their efforts to test whether involuntary out-patient commitment (OPC) may help to reduce the incidence of violence among persons with SMI. They describe their research methodology as a one-year randomized trial of the effectiveness of OPC in 262 subjects with psychotic or major mood disorders and a history of hospital recidivism. Involuntarily hospitalized subjects awaiting OPC were randomly assigned to release or court-ordered treatment after discharge. Those with a recent history of serious assault remained under OPC until expiry of the court order (up to 90 days); then OPC orders were renewed at clinical/court discretion. Control subjects had no OPC. One follow-up interview took place every four months with subject, case manager, and collateral informant, and service records were collected. Results showed a significantly lower incidence of violent behavior occurring in subjects with more than months' OPC; and lowest risk of violence was associated with extended OPC combined with regular out-patient services, adherence to prescribed medications, and no substance misuse. The authors conclude that OPC may significantly reduce risk of violent behavior in persons with SMI, in part by improving adherence to medications while diminishing substance misuse. Publisher Abstract Provided