Mental Health Services Research

, Volume 5, Issue 1, pp 27–38 | Cite as

Involuntary Outpatient Commitment and Homelessness in Persons with Severe Mental Illness

  • Scott N. Compton
  • Jeffrey W. Swanson
  • H. Ryan Wagner
  • Marvin S. Swartz
  • Barbara J. Burns
  • Eric B. Elbogen


This study took preliminary steps to explore the relationship between involuntary outpatient commitment (OPC) and the risk of homelessness among individuals with severe mental disorders. Involuntarily hospitalized patients were randomly assigned to be released or maintained under OPC following hospital discharge. Multivariate analyses demonstrated that involuntary OPC was associated with a significant decrease in the risk of homelessness during the first 4 months following hospital discharge for participants with severe functional impairment at baseline. OPC did not appear to affect risk of homelessness among participants with mild-to-moderate functional impairment. Co-occurring substance abuse, treatment nonadherence, and outpatient services intensity were found to be strongly associated with episodes of homelessness. This study suggests that involuntary OPC may provide a short-term reduction in the risk of homelessness among a subgroup of treatment-reluctant individuals with severe mental disorders combined with severe functional impairment.

homeless persons involuntary outpatient commitment mental disorders treatment outcome 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Brunette, M., & Drake, R. E., (1998). Gender differences in homeless persons with schizophrenia and substance abuse. Community Mental Health Journal, 34(6), 627-642.Google Scholar
  2. Burnam, M. A., Morton, S. C., McGlynn, E. A., Petersen, L. P., Stecher, B. M., Hayes, C., et al. (1995). An experimental evaluation of residential and nonresidential treatment for dually diagnosed homeless adults. Journal of Addictive Diseases, 14(4), 111-134.Google Scholar
  3. Caton, C. L. (1995). Mental health service use among homeless and never-homeless men with schizophrenia. Psychiatric Services, 46(11), 1139-1143.Google Scholar
  4. Caton, C. L., Shrout, P. E., Dominguez, B., Eagle, P. F., Opler, L. A., & Cournos, F. (1995). Risk factors for homelessness among women with schizophrenia. American Journal of Public Health, 85, 1153-1156.Google Scholar
  5. Conrad, K. J., Matters, M. D., Hanrahan, P., Luchins, D. J., Savage, C., & Daugherty, B. (1998). Characteristics of persons with mental illness in a representative payee program. Psychiatric Services, 49, 1223-1225.Google Scholar
  6. Dennis, D. L., Buckner, J. C., Lipton, F. R., & Levine, I. S. (1991). A decade of research and services for homeless mentally ill persons. Where do we stand? American Psychologist, 46(11), 1129-1138.Google Scholar
  7. Dixon, L. B., Krauss, N., Kernan, E., Lehman, A. F., & DeForge, B. R. (1995). Modifying the PACT model to serve homeless persons with severe mental illness. Psychiatric Services, 46(7), 684-688.Google Scholar
  8. Drake, R. E., Wallach, M. A., & Hoffman, J. S. (1989). Housing instability and homelessness among aftercare patients of an urban state hospital. Hospital and Community Psychiatry, 40(1), 46-51.Google Scholar
  9. Fernandez, G. A., & Nygard, S. (1990). Impact of involuntary outpatient commitment on the revolving-door syndrome in North Carolina. Hospital and Community Psychiatry, 41(9), 1001-1004.Google Scholar
  10. Geller, J., Grudzinskas, A. J., Jr., McDermeit, M., Fisher, W. H., & Lawlor, T. (1998). The efficacy of involuntary outpatient treatment in Massachusetts. Administration and Policy in Mental Health, 25(3), 271-285.Google Scholar
  11. Herman, D. B., Susser, E. S., Jandorf, L., Lavelle, J., & Bromet, E. J. (1998). Homelessness among individuals with psychotic disorders hospitalized for the first time: Findings from the Suffolk County Mental Health Project. American Journal of Psychiatry, 155(1), 109-113.Google Scholar
  12. Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. New York: Wiley.Google Scholar
  13. Koocher, G. P., Norcross, J. C, & Hill, S. S. (Eds.). (1998). Psychologists' desk reference. New York: Oxford University Press.Google Scholar
  14. Lehman, A. F., Dixon, L. B., Kernan, E., DeForge, B. R., & Postrado, L. T. (1997). A randomized trial of assertive community treatment for homeless persons with severe mental illness. Archives of General Psychiatry, 54(11), 1038-1043.Google Scholar
  15. Link, B. G., Susser, E., Stueve, A., Phelan, J., Moore, R. E., & Stuening, E. (1994). Lifetime and five-year prevalence of homelessness in the United States. American Journal of Public Health, 84(12), 1907-1912.Google Scholar
  16. Loevdahl, H., & Friis, S. (1996). Routine evaluation of mental health: Reliable information or worthless “guesstimates”? Acta Psychiatrica Scandinavica, 93(2), 125-128.Google Scholar
  17. Meisler, N., Blankertz, L., Santos, A. B., & McKay, C. (1997). Impact of assertive community treatment on homeless persons with co-occurring severe psychiatric and substance use disorders. Community Mental Health Journal, 33(2), 113-122.Google Scholar
  18. Morse, G. A., Calsyn, R. J., Allen, G., & Kenny, D. A. (1994). Helping homeless mentally ill people: What variables mediate and moderate program effects? American Journal of Community Psychology, 22(5), 661-683.Google Scholar
  19. Narendran, R., Young, C. M., Valenti, A. M., Pristach, C. A., Pato, M. T., & Grace, J. J. (2001). Olanzapine therapy in treatment-resistant psychotic mood disorders: A long-term follow-up study. Journal of Clinical Psychiatry, 62(7), 509-516.Google Scholar
  20. Olfson, M., Mechanic, D., Hansell, S., Boyer, C. A., & Walkup, J. (1999). Prediction of homelessness within three months of discharge among inpatients with schizophrenia. Psychiatric Services, 50(5), 667-673.Google Scholar
  21. Opler, L. A., Caton, C. L., Shrout, P., Dominguez, B., & Kass, F. I. (1994). Symptom profiles and homelessness in schizophrenia. Journal of Nervous and Mental Disease, 183(3), 174-178.Google Scholar
  22. Quinsey, V. L., Harris, G. T., Rice, M. E., & Cormier, C. A. (1998). Violent offenders: Appraising and managing risk. Washington, DC: American Psychological Association.Google Scholar
  23. Rahav, M., Nuttbrock, L., Rivera, J. J., & Link, B. G. (1998). HIV infection risks among homeless, mentally ill, chemical misusing men. Substance Use and Misuse, 33(6), 1407-1426.Google Scholar
  24. Rahav, M., Rivera, J. J., Nuttbrock, L., Ng-Mak, D., Sturz, E. L., Link, B. G., et al. (1995). Characteristics and treatment of homeless, mentally ill, chemical-abusing men. Journal of Psychoactive Drugs, 27(1), 93-103.Google Scholar
  25. Roy-Byrne, P., Dagadakis, C., Unutzer, J., & Ries, R. (1996) Evidence for limited validity of the Revised Global Assessment of Functioning Scale. Psychiatric Services, 47, 864-866.Google Scholar
  26. Schwartz, J. E., Fennig, S., Tanenberg-Karant, M., Carlson, G., Craig, T., Galambos, N., et al. (2000). Congruence of diagnosis 2 years after a first-admission diagnosis of psychosis. Archives of General Psychiatry, 57(6), 593-600.Google Scholar
  27. Shern, D. L., Tsemberis, S., Anthony, W., Lovell, A. M., Richmond, L., Felton, C. J., et al. (2000). Serving street-dwelling individuals with psychiatric disabilities: Outcomes of a psychiatric rehabilitation clinical trial. American Journal of Public Health, 90(12), 1873-1878.Google Scholar
  28. Silver, E., Mulvey, E., & Monahan, J. (1999). Assessing violence risk among discharged patients: Toward an ecological approach. Law and Human Behavior, 23, 237-255.Google Scholar
  29. Spitzer, R. L., Williams, J. B. W., Gibbons, M., & First, M. B. (1990). Structured clinical interview for DSM-III-R. Washington, DC: American Psychiatric Press.Google Scholar
  30. Steadman, H., Silver, E., Monahan, J., Appelbaum, P. S., Robbins, P. C., Mulvey, E. P., et al. (2000). A classification tree approach to the development of actuarial violence risk assessment tools. Law and Human Behavior, 24, 83-100.Google Scholar
  31. Susser, E. S., Lin, S. P., & Conover, S. A. (1991). Risk factors for homelessness among patients admitting to a state mental hospital. American Journal of Psychiatry, 148(12), 1659-1664.Google Scholar
  32. Susser, E., Moore R., & Link, B. (1993). Risk factors for homelessness. Epidemiologic Reviews, 15(2), 546-556.Google Scholar
  33. Susser, E., Valencia, E., Berkman, A., Sohler, N., Conover, S., Torres, J., et al. (1998). Human immunodeficiency virus sexual risk reduction in homeless men with mental illness. Archives of General Psychiatry, 55(3), 266-272.Google Scholar
  34. Susser, E., Valencia, E., Conover, S., Felix, A., Tsai, W. Y., & Wyatt, R. J. (1997). Preventing recurrent homelessness among mentally ill men: A “critical time” intervention after discharge from a shelter. American Journal of Public Health, 87(2), 256-262.Google Scholar
  35. Swanson, J. W., Borum, R., Swartz, M. S., Hiday, V. A., Wagner, H. R., & Burns, B. J. (2001). Can involuntary outpatient commitment reduce arrests among persons with severe mental illness. Criminal Justice and Behavior, 28(2), 156-189.Google Scholar
  36. Swanson, J. W., Swartz, M. S., George, L. K., Burns, B. J., Hiday, V. A., Borum, R., et al. (1997). Interpreting the effectiveness of involuntary outpatient commitment: A conceptual model. Journal of the American Academy of Psychiatry and the Law, 25(1), 5-16.Google Scholar
  37. Swartz, M. S., Swanson, J. W., Hiday, V. A., Borum, R., Wagner, R., & Burns, B. J. (1998). Taking the wrong drugs: The role of substance abuse and medication noncompliance in violence among severely mentally ill individuals. Social Psychiatry and Psychiatric Epidemiology, 33Suppl. 1), S75-S80.Google Scholar
  38. Swartz, M. S., Swanson, J. W., Wagner, H. R., Burns, B. J., & Hiday, V. A. (2001). Effects of involuntary outpatient commitment and depot antipsychotics on treatment adherence in persons with severe mental illness. Journal of Nervous and Mental Disease, 189(9), 583-592.Google Scholar
  39. Swartz, M. S., Swanson, J. W., Wagner, H. R., Burns, B. J., Hiday, V. A., & Borum, R. (1999). Can involuntary outpatient commitment reduce hospital recidivism?: Findings from a randomized trial with severely mentally ill individuals. American Journal of Psychiatry, 156(12), 1968-1975.Google Scholar
  40. Toro, P. A., Passero Rabideau, J. M., Bellavia, C. W., Daeschler, C. V., Wall, D. D., Thomas, D. M., et al. (1997). Evaluating an intervention for homeless persons: Results of a field experiment. Journal of Consulting and Clinical Psychology, 65(3), 476-484.Google Scholar
  41. Wasylenki, D. A., Goering, P. N., Lemire, D., Lindsey, S., & Lancee, W. (1993). The hostel outreach program: Assertive case management for homeless mentally ill persons. Hospital and Community Psychiatry, 44(9), 848-853.Google Scholar
  42. Webster, C. D., Douglas, K. S., Eaves, D., & Hart, S. D. (1997). The HCR-20 Scheme: The assessment of dangerousness and risk (Version 2). Burnaby, British Columbia: Simon Fraser University and Forensic Psychiatric Services Commission of British Columbia.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Scott N. Compton
    • 1
  • Jeffrey W. Swanson
    • 1
  • H. Ryan Wagner
    • 1
  • Marvin S. Swartz
    • 1
  • Barbara J. Burns
    • 1
  • Eric B. Elbogen
    • 1
  1. 1.Department of Psychiatry & Behavioral SciencesDuke University Medical CenterDurham

Personalised recommendations