The Perceived Coerciveness of Involuntary Outpatient Commitment: Findings From an Experimental Study

M. S. Swartz, H. R. Wagner, J. W. Swanson and P. Virginia A. Hiday, and Barbara J. Burns
Journal of the American Academy of Psychiatry and the Law 30(2): 207-217, 2002.
This study examines self-reported coercion in subjects with severe mental illness who were randomly assigned in an experimental study to continue under, or be released from, involuntary outpatient commitment (OPC) subsequent to hospital discharge. After review of bivariate relationships, multivariable analyses demonstrated significantly higher levels of reported coercion among subjects who experienced longer periods of OPC; who were African American; who were single and not cohabiting; and who had ongoing substance abuse problems, poor insight into illness, and severe symptoms. Case managers' verbal reminders to subjects about the consequences of nonadherence to treatment partially account for higher reports of coercion. Previous reports from this study have found that OPC, if sustained and combined with frequent outpatient mental health services, can improve some outcomes. The current analyses demonstrate that a consequence of OPC is increased perceptions of coercion in the treatment process, which is partially explained by the increased attention by case managers to noncompliance with treatment.