Involuntary out-patient commitment and reduction of violent behaviour in persons with severe mental illness.

Journal Article (Clinical Trial;Journal Article)

BACKGROUND: Violent behaviour among persons with severe mental illness (SMI) causes public concern and is associated with illness relapse, hospital recidivism and poor outcomes in community-based treatment. AIMS: To test whether involuntary out-patient commitment (OPC) may help to reduce the incidence of violence among persons with SMI. METHOD: One-year randomised trial of the effectiveness of OPC in 262 subjects with psychotic or major mood disorders and a history of hospital recidivism. Involuntarily hospitalised 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. Four-monthly follow-up interviews with subject, case manager and collateral informant took place and service records were collected. RESULTS: A significantly lower incidence of violent behaviour occurred in subjects with > or = 6 months' OPC. Lowest risk of violence was associated with extended OPC combined with regular out-patient services, adherence to prescribed medications and no substance misuse. CONCLUSIONS: OPC may significantly reduce risk of violent behaviour in persons with SMI, in part by improving adherence to medications while diminishing substance misuse.

Full Text

Duke Authors

Cited Authors

  • Swanson, JW; Swartz, MS; Borum, R; Hiday, VA; Wagner, HR; Burns, BJ

Published Date

  • April 2000

Published In

Volume / Issue

  • 176 /

Start / End Page

  • 324 - 331

PubMed ID

  • 10827879

International Standard Serial Number (ISSN)

  • 0007-1250

Digital Object Identifier (DOI)

  • 10.1192/bjp.176.4.324


  • eng

Conference Location

  • England