Involuntary Outpatient Commitment
In 1955, over 559,000 individuals resided in inpatient psychiatric hospitals. By 1995, however, the number had drastically diminished to 69,000, (National Health Policy Forum, 2000). This drastic reduction was largely due to the discovery of antipsychotic medications in the 1950s, and the deinstitutionalization movement of the 1960s, wherein several thousands of mentally ill individuals were released from psychiatric institutions to return to their communities for treatment. Mental health centers (MHCs) were conceptualized during deinstitutionalization to provide treatment to these newly-released mentally ill persons in their communities. Although efforts were well-intended, the MHCs failed to serve the neediest subset of individuals. Instead, they served those who had minor psychiatric diagnoses and needed little treatment. As a result, the United States experienced an increase in the number of homeless individuals, most of whom still exhibited psychotic symptoms. Involuntary Outpatient Commitment (IOC) was created to serve those “forgotten” mentally ill individuals without placing them back in institutions. Ideally, IOC will increase community tenure for the severely mentally ill, decrease the likelihood of decompensation, and provide the necessary treatment by means less restrictive than hospitalization, (Borum et al., 1999).
IOC is a civil procedure whereby a judge orders a person with a mental illness to comply with outpatient treatment within the community, or risk sanctions such as being forcibly brought to treatment by law enforcement officials, (Swartz et al., 2003). The legal authority in IOC is the state’s parens patriae power, which provides for the protection of disabled individuals, and its police power, which involves the protection of others. IOC is commonly used for persons with schizophrenia, bipolar disorder, or other psychoses, especially if there is a history of medication non-compliance or repeated inpatient psychiatric admissions, (Torrey & Kaplan, 1995). The national Department of Mental Health receives a certain amount of money each year from the federal government. From this, state mental health departments draw a significant amount of their funds. It is through the state mental health departments that IOC is largely funded. Although IOC is delivered at the local level, those municipalities receive funds from their state mental health department.
IOC was created largely through mandates provided by the Olmstead Act (1999). The Olmstead Act requires public agencies to provide services “in the most integrated setting appropriate to the needs of qualified individuals with disabilities.” Further, the act mandates that states place qualified individuals with mental illnesses in community settings, rather than in institutions. Being placed under IOC is contingent upon whether or not such placement is appropriate, affected persons do not oppose such placement, and the state can...