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FORENSIC PSYCHIATRY PAPERS |
Services Effectiveness Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
Department of Mental Health Law and Policy, Florida Mental Health Institute, University of South Florida, Tampa, FL
Department of Sociology, North Carolina State University, Raleigh, NC, USA
Declaration of interest Funded by the National Institute of Mental Health.
See editorial pp.
307–311, this issue.
Correspondence: Jeffrey Swanson, Assistant Professor in Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3071, Brightleaf Square Suite 23-A, Durham, NC 27710, USA. Tel: (919) 682 4827; Fax: (919) 682 1907; e-mail: Jeffrey.Swanson{at}Duke.edu
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 
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.
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