Skip to main content
Log in

Clinical Encounters with Outpatient coercion at the CMHC: Questions of Implementation and efficacy

  • Article
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

Clinical encounters with three outpatients at a CMHC who were managed with alternating periods of voluntary or uncoerced and involuntary or coerced treatment are presented. The two periods of coerced community treatment—of eight months and then two to four years duration—produced positive results quite distinct from the periods of uncoerced community treatment. In discussing the implementation and efficacy of coerced outpatient treatment at the CMHC, the author addresses legal, clinical, and resource issues which form the basis for seven arguments often heard as to why staffs at CMHCs hesitate to employ involuntary or coercive interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Abroms, G.M (1968). Setting limits.Archives of General Psychiatry, 19, 113–119.

    Google Scholar 

  • American Psychiatric Association (1987)Involuntary Commitment to Outpatient Treatment, Task Force Report 26. Washington, D.C., American Psychiatric Association.

    Google Scholar 

  • Appelbaum, P.S. (1986). Outpatient commitment: The problems and the promises.American Journal of Psychiatry, 143, 1270–1272.

    Google Scholar 

  • Appelbaum, P.S., Zonana, H., Bonnie, R., et al. (1989). Statutory approaches to limiting psychiatrists' liability for their patients' violent acts.American Journal of Psychiatry, 146, 821–827.

    Google Scholar 

  • Application of True, 645P. 2d 891 (Idaho 1982).

  • Aviram, U. (1990). Community care of the seriously mentally ill: Continuing problems and current issues.Community Mental Health Journal, 26, 69–88.

    Google Scholar 

  • Belcher, J.R. (1988). Are jails replacing the mental health system for the homeless mentally ill?Community Mental Health Journal, 24, 185–195.

    Google Scholar 

  • Bloom, J.D., Williams, M.H., Rogers, J. L. et al. (1986). Evaluation and treatment of insanity acquittees in the community.Bulletin of the American Academy of Psychiatry and the Law, 14, 231–244.

    Google Scholar 

  • Cavanaugh, J.L., & Wasyliw, O.E. (1985). Treating the not guilty by reason of insanity outpatient: A two-year study.Bulletin of the American Academy of Psychiatry and the Law, 13, 407–415.

    Google Scholar 

  • Deutsch, A. (1948).The shame of the States. New York: Harcourt Brace.

    Google Scholar 

  • Dietrich v. Brooks, 558 P. 2d 357 (Or. App. 1976).

  • Falloon, I.R.H. (1984). Developing and maintaining adherence to long-term drug-taking regimens.Schizophrenia Bulletin 10, 412–417.

    Google Scholar 

  • Ferrell, R.B., Price, T.R.P., Gert, B., et al. (1984). Volitional disability and physician attitudes toward noncompliance.Journal of Medicine and Philosophy, 9, 333–351.

    Google Scholar 

  • Geller, J.L. (1984). Rights, wrongs, and the dilemma of coerced community treatment.American Journal of Psychiatry, 143, 1259–1264.

    Google Scholar 

  • Geller, J.L. (1986a). In again, out again: Preliminary evaluation of a state hospital's worst recidivists.Hospital and Community Psychiatry, 37, 386–390.

    Google Scholar 

  • Geller, J.L. (1986b). The quandaries of enforced communitytreatment and unenforceable outpatient commitment status.Journal of Psychiatry and Law, 14, 273–279.

    Google Scholar 

  • Geller, J.L. (1990). Clinical guidelines for the use of involuntary outpatient treatment.Hospital and Community Psychiatry, 41, 749–755.

    Google Scholar 

  • Goldman, H.H., Adams, N.H., & Taube, C.A. (1983). Deinstitutionalization: The data demythologized.Hospital and Community Psychiatry 34, 129–134.

    Google Scholar 

  • Gorman, M. (1956).Every Other Bed. Cleveland, World Publishing Company.

    Google Scholar 

  • Gralnick, A. (1985). Build a better state hospital: Deinstitutionalization has failed.Hospital and Community Psychiatry, 36, 738–741.

    Google Scholar 

  • Green, S.A. (Ed), Goldbert, R.L., Goldstein, D.M., et al. (1988).Limit Setting in Clinical Practice. Washington, D.C.: American Psychiatric Press.

    Google Scholar 

  • Harris, M., & Bergman, H.C. (1987). Differential treatment planning for young adult chronic patients.Hospital and Community Psychiatry, 38, 638–643.

    Google Scholar 

  • Harry, B., & Steadman, J.H. (1988). Arrest rates of patients treated at a community mental health center.Hospital and Community Psychiatry, 39, 862–866.

    Google Scholar 

  • Hoge, S.K., Appelbaum, P.S., & Geller, J.L. (1989). Involuntary treatment, in A. Tasman, R. B. Hales, & A.J. Frances, (Eds.)Review of Psychiatry, Volume 8. Washington, D.C.: American Psychiatric Press.

    Google Scholar 

  • Hooks v. Jaquith, 318 So. 2d 860 (Miss. 1975).

  • Interest of Cuypers, 389 N.W. 2d 812 (N.D. 1986).

  • Isaac, R.J. & Armat, V.C. (1990)Madness in the Streets. New York: Free Press.

    Google Scholar 

  • Johnson, A.B. (1990).Out of Bedlam, New York: Basic Books.

    Google Scholar 

  • Keilitz, I. & Hall, T. (1985). State statutes governing involuntary outpatient civil commitment.Mental and Physical Disability Law Reporter, 9, 378–397.

    Google Scholar 

  • Lamb, H.R., Weinberger, L.E., & Gross, B.H. (1988). Court-mandated community outpatient treatment for persons found not guilty by reason of insanity: A five-year follow-up.American Journal of Psychiatry, 145, 450–456.

    Google Scholar 

  • MacDonald, J.M. (1965). Acting Out.Archives of General Psychiatry, 13, 439–443.

    Google Scholar 

  • McEvon, J.P., Appelbaum, P.S., Apperson, L.J., et al. (1989). Why must some schizophrenic patients be involuntarily committed? The role of insight.Comprehensive Psychiatry, 30, 13–17, 1989.

    Google Scholar 

  • McEvoy, J.P., Apperson, L.J., Appelbaum, P.S., et al. (1989). Insight in schizophrenia. Its relationship to acute psychopathology.Journal of Nervous and Mental Disorders, 177, 43–47.

    Google Scholar 

  • McEvoy, J.P., Freter, S., Everett, G., et al. (1989). Insight and the clinical outcome of schizophrenic patients.Journal of Nervous and Mental Disorders, 177, 45–51.

    Google Scholar 

  • Miller, R.D. (1987)Involuntary Civil Commitment of the Mentally Ill in the Post-Reform Era. Springfield, IL: Charles C. Thomas.

    Google Scholar 

  • Miller, R.D. (1988). Outpatient civil commitment of the mentally ill: An overview and an update.Behavioral Science and the Law, 6, 99–118.

    Google Scholar 

  • Miller, R.D. & Fiddelman, P.B. (1984). Outpatient commitment: Treatment in the least restrictive environment.Hospital and Community Psychiatry, 35, 147–151.

    Google Scholar 

  • Mulvey, E.P., Geller, J.L., & Roth, L.H. (1987). The promise and peril of involuntary outpatient commitment.American Psychologist, 42, 571–584.

    Google Scholar 

  • Okin, R.L. (1985). Expand the community care system: Deinstitutionalization can work.Hospital and Community Psychiatry, 36, 742–745.

    Google Scholar 

  • Owens, J.S. (1985, November),Involuntary Outpatient Commitment. An Exploration of the Issues and its Utilization in Five States. Rockville, MD, National Institute of Mental Health.

    Google Scholar 

  • Pepper, B. (1987). A public policy for the long-term mentally ill: A positive alternative to reinstitutionalization.American Journal of Orthopsychiatry, 57, 452–457.

    Google Scholar 

  • Pepper, B. & Ryglewicz, H. (1984). Treating the young adult chronic patient, An update, in B. Pepper & H. Ryglewicz (Eds),Advances in Treating the Young Adult Chronic Patient. San Francisco: Jossey-Bass.

    Google Scholar 

  • re James, 507 A. 2d 155 (D.C. App. 1986).

  • re McPherson, 222 Cal Rptr 416 (Cal. App. 1 Dist. 1985).

  • re Mills, 467 A. 2d 971 (D.C. App. 1983).

  • re Peterson, 360 N.W. 2d 333 (Minn. 1984).

  • re Richardson, 481 A. 2d 473 (D.C. App. 1984).

  • Rhode Island Department of Mental Health, Retardation and Hospitals v. R.B., 549 A. 2d (R.I. 1988).

  • Schmidt, M.J. & Geller, J.L. (1989). Involuntary administration of medication in the community—the judicial opportunity.Bulletin of the American Academy of Psychiatry and the Law, 17, 283–292.

    Google Scholar 

  • Schwartz, S.J. & Costanzo, C.E. (1987).Compelling treatment in the community: Distorted doctrines and violated values. Loyola of Los Angeles Law Review, 20, 1329–1429.

    Google Scholar 

  • Solomon, P., Davis, J., & Gordon, B. (1984). Discharged state hospital patients'characteristics and use of aftercare: Effect on community tenure.American Journal of Psychiatry, 141, 1566–1570.

    Google Scholar 

  • Stefan, S. (1987). Preventive commitment: The concept and its pitfalls.Mental and Physical Disability Law Reporter, 11, 288–302.

    Google Scholar 

  • Torrey, E.F. (1988).Nowhere To Go. New York, Harper & Row.

    Google Scholar 

  • Van Putten, T. (1975). Why do patients with manic-depressiveillness stop their lithium?Comprehensive Psychiatry, 16, 179–183.

    Google Scholar 

  • Van Putten, T. (1983). The clinical management of noncompliance In I. Barotsky & R.D. Budson,The Chronic Psychiatric Patient in the Community, New York:Spectrum.

    Google Scholar 

  • Wilk, R.J. (1988) Implications of involuntary outpatient commitment for community mental health agencies.American Journal of Orthopsychiatry, 58, 580–591.

    Google Scholar 

  • Young, J.L., Zonana, A.V., Shepler, L. (1986). Medication noncompliance in schizophrenia: Codification and update.Bulletin of the American Academy of Psychiatryand the Law, 14, 105–122.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Geller, J.L. Clinical Encounters with Outpatient coercion at the CMHC: Questions of Implementation and efficacy. Community Ment Health J 28, 81–94 (1992). https://doi.org/10.1007/BF00754275

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00754275

Keywords

Navigation