Editing Outpatient commitment (section)

====Effect on mental illness system====
=====Access to services=====
{{blockquote|"AOT has been instrumental in increasing accountability at all system levels regarding delivery of services to high need individuals. Community awareness of AOT has resulted in increased outreach to individuals who had previously presented engagement challenges to mental health service providers."}}

{{blockquote|"Improved treatment plan development, discharge planning, and coordination of service planning. 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."}}

{{blockquote|"Improved collaboration between mental health and court systems. 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. There is now an organized process to prioritize and monitor individuals with the greatest need; AOT ensures greater access to services for individuals whom providers have previously been reluctant to serve;  There is now increased collaboration between inpatient and community-based providers."<ref>{{cite report |author=New York State Office of Mental Health |date=2005 |title=Kendra's Law: Final Report on the Status of Assisted Outpatient Treatment |type=Report to Legislature |publisher=New York State |location=Albany |page=60 |url=http://mentalillnesspolicy.org/kendras-law/research/kendras-law-study-2005.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://mentalillnesspolicy.org/kendras-law/research/kendras-law-study-2005.pdf |archive-date=2022-10-09 |url-status=live |access-date=8 February 2015 }}</ref>}}

In New York City net costs declined 50% in the first year after assisted outpatient treatment began and an additional 13% in the second year. In non-NYC counties, costs declined 62% in the first year and an additional 27% in the second year. 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. The increased community-based mental health costs were more than offset by the reduction in inpatient and incarceration costs. Cost declines associated with assisted outpatient treatment were about twice as large as those seen for voluntary services.<ref name=AJP73013/>{{primary source inline|date=October 2017}}

{{blockquote|"In all three regions, for all three groups, the predicted probability of an {{abbr|MPR|Medication Possession Ratio}} ≥80% improved over time (AOT improved by 31–40 percentage points, followed by enhanced services, which improved by 15–22 points, and 'neither treatment,' improving 8–19 points). Some regional differences in MPR trajectories were observed."<ref>{{cite journal |last1=Busch |first1=Alisa B. |last2=Wilder |first2=Christine M. |last3=Van Dorn |first3=Richard A. |last4=Swartz |first4=Marvin S. |last5=Swanson |first5=Jeffrey W. |display-authors=3 |title=Changes in Guideline-Recommended Medication Possession After Implementing Kendra's Law in New York |journal=Psychiatric Services |volume=61 |issue=10 |year=2010 |pages=1000–5 |doi=10.1176/ps.2010.61.10.1000 |pmid=20889638 |pmc=6690587 }}</ref>{{primary source inline|date=October 2017}}}}

{{blockquote|"In tandem with New York's AOT program, enhanced services increased among involuntary recipients, whereas no corresponding increase was initially seen for voluntary recipients. In the long run, however, overall service capacity was increased, and the focus on enhanced services for AOT participants appears to have led to greater access to enhanced services for both voluntary and involuntary recipients."<ref>{{cite journal |last1=Swanson |first1=Jeffrey W. |last2=Van Dorn |first2=Richard A. |last3=Swartz |first3=Marvin S. |last4=Cislo |first4=Andrew M. |last5=Wilder |first5=Christine M. |last6=Moser |first6=Lorna L. |last7=Gilbert |first7=Allison R. |last8=McGuire |first8=Thomas G. |display-authors=3 |title=Robbing Peter to Pay Paul: Did New York State's Outpatient Commitment Program Crowd Out Voluntary Service Recipients? |journal=Psychiatric Services |volume=61 |issue=10 |year=2010 |pages=988–95 |doi=10.1176/ps.2010.61.10.988 |pmid=20889636 |doi-access=free }}</ref>{{primary source inline|date=October 2017}}}}

{{blockquote|"It is also important to recognize that the AOT order exerts a critical effect on service providers stimulating their efforts to prioritize care for AOT recipients."{{cite quote|date=August 2016}}}}

=====Race=====
{{blockquote|"We find no evidence that the AOT Program is disproportionately selecting African Americans for court orders, nor is there evidence of a disproportionate effect on other minority populations. Our interviews with key stakeholders across the state corroborate these findings."}}

{{blockquote|"We found no evidence of racial bias. Defining the target population as public-system clients with multiple hospitalizations, the rate of application to white and black clients approaches parity."<ref>{{cite journal |last1=Swanson |first1=Jeffrey |last2=Swartz |first2=Marvin |last3=Van Dorn |first3=Richard A. |last4=Monahan |first4=John |last5=McGuire |first5=Thomas G. |last6=Steadman |first6=Henry J. |last7=Robbins |first7=Pamela Clark |display-authors=3 |title=Racial Disparities In Involuntary Outpatient Commitment: Are They Real? |journal=Health Affairs |volume=28 |issue=3 |year=2009 |pages=816–26 |doi=10.1377/hlthaff.28.3.816 |doi-access= |pmid=19414892 }}</ref>{{primary source inline|date=October 2017}}}}

=====Service engagement=====
{{blockquote|"After 12 months or more on AOT, service engagement increased such that AOT recipients were judged to be more engaged than voluntary patients. This suggests that after 12 months or more, when combined with intensive services, AOT increases service engagement compared to voluntary treatment alone."}}
Consumers approve.  Despite being under a court order to participate in treatment, current AOT recipients feel neither more positive nor more negative about their treatment experiences than comparable individuals who are not under AOT."<ref name=pmid20889634/>{{failed verification|date=October 2017}}

{{blockquote|"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."<ref name="Van Dorn et al 2010">{{cite journal |last1=Van Dorn |first1=Richard A. |last2=Swanson |first2=Jeffrey W. |last3=Swartz |first3=Marvin S. |last4=Wilder |first4=Christine M. |last5=Moser |first5=Lorna L. |last6=Gilbert |first6=Allison R. |last7=Cislo |first7=Andrew M. |last8=Robbins |first8=Pamela Clark |display-authors=3 |title=Continuing Medication and Hospitalization Outcomes After Assisted Outpatient Treatment in New York |journal=Psychiatric Services |volume=61 |issue=10 |date=October 2010 |pages=982–7 |doi=10.1176/ps.2010.61.10.982 |doi-access= |pmid=20889635 }}</ref>{{primary source inline|date=October 2017}}}}

In Los Angeles, CA, the AOT pilot program reduced incarceration 78%, hospitalization 86%, hospitalization after discharge from the program 77%, and cut taxpayer costs 40%.<ref>{{cite report |last=Southard |first=Marvin |date=February 24, 2011 |title=Assisted Outpatient Treatment Program Outcomes Report |publisher=Los Angeles County Department of Mental Health |location=Los Angeles, CA |url=http://lauras-law.org/states/california/lalauraslawstudy.pdf |access-date=24 September 2014 |url-status=dead |archive-url=https://web.archive.org/web/20131228224756/http://lauras-law.org/states/california/lalauraslawstudy.pdf |archive-date=28 December 2013 }}</ref>

In North Carolina, AOT reduced the percentage of persons refusing medications to 30%, compared to 66% of patients not under AOT.<ref>{{cite journal |last1=Hiday |first1=Virginia Aldigé |last2=Scheid-Cook |first2=Teresa L. |title=The North Carolina experience with outpatient commitment: A critical appraisal |journal=International Journal of Law and Psychiatry |volume=10 |issue=3 |year=1987 |pages=215–32 |doi=10.1016/0160-2527(87)90026-4 |pmid=3692660 }}</ref>

In Ohio, AOT increased attendance at outpatient psychiatric appointments from 5.7 to 13.0 per year. It increased attendance at day treatment sessions from 23 to 60 per year. "During the first 12 months of outpatient commitment, patients experienced significant reductions in visits to the psychiatric emergency service, hospital admissions, and lengths of stay compared with the 12 months before commitment."<ref>{{cite journal |title=The effectiveness of outpatient civil commitment |journal=Psychiatric Services |volume=47 |issue=11 |date=November 1996 |pages=1251–3 |doi=10.1176/ps.47.11.1251 |pmid=8916245 |last1=Munetz |first1=M.R. |last2=Grande |first2=T. |last3=Kleist |first3=J. |last4=Peterson |first4=G.A.  |display-authors=3 |citeseerx=10.1.1.454.5055 }}</ref>{{primary source inline|date=October 2017}}

In Arizona, "71% [of AOT patients] ... voluntarily maintained treatment contacts six months after their orders expired" compared with "almost no patients" who were not court-ordered to outpatient treatment.<ref>{{cite journal |vauthors=Van Putten RA, Santiago JM, Berren MR |title=Involuntary outpatient commitment in Arizona: a retrospective study |journal=Hospital & Community Psychiatry |volume=39 |issue=9 |pages=953–8 |date=September 1988 |pmid=3215643 |doi=10.1176/ps.39.9.953 }}</ref>{{primary source inline|date=October 2017}}

In Iowa, "it appears as though outpatient commitment promotes treatment compliance in about 80% of patients... After commitment is terminated, about ¾ of that group remain in treatment on a voluntary basis."<ref>{{cite report |last=Rohland |first=Barbara |date=1998 |title=The role of outpatient commitment in the management of persons with schizophrenia |publisher=Iowa Consortium for Mental Health Services, Training and Research |url=http://www.healthcare.uiowa.edu/icmh/archives/reports/finalrpt.pdf |access-date=25 September 2014 |archive-url=https://web.archive.org/web/20160204112043/http://www.healthcare.uiowa.edu/icmh/archives/reports/finalrpt.pdf |archive-date=4 February 2016 |url-status=dead }}</ref>