Effects of involuntary outpatient commitment on subjective quality of life in persons with severe mental illness
Abstract
Recent evidence suggests that involuntary outpatient commitment (OPC), when appropriately applied, can improve adherence with psychiatric treatment, decrease hospital recidivism and arrests, and lower the risk of violent behavior in persons with severe mental illness. Presumably these are benefits that improve quality of life (QOL); however, insofar as OPC involves legal coercion, the undesirable aspects of OPC could also exert a negative effect on quality of life, thus offsetting clinical benefits. Involuntarily hospitalized subjects, awaiting discharge under outpatient commitment, were randomly assigned to be released or continue under outpatient commitment in the community after hospital discharge, and were followed for one year. Quality of life was measured at baseline and 12 months follow-up. Treatment characteristics and clinical outcomes were also measured. Subjects who underwent longer periods of outpatient commitment had significantly greater quality of life as measured at the end of the 1 year study. Multivariable analysis showed that the effect of OPC on QOL was mediated by greater treatment adherence and lower symptom scores. However, perceived coercion moderated the effect of OPC on QOL. Involuntary outpatient commitment, when sustained over time, indirectly exerts a positive effect on subjective quality of life for persons with SMI, at least in part by improving treatment adherence and lowering symptomatology.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Patients subjected to outpatient commitment were more likely to perceive coercion.
“Patients subjected to outpatient commitment were more likely to perceive coercion [24,57,65,92,95,107]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [57]
Cites
The brief symptom inventory: an introductory report.
Derogatis, L. R., & Melisaratos, N. (1983) · Psychological Medicine · doi:10.1017/s0033291700048017 · Cited by 6,650 · see citing works
The Global Assessment Scale: A Procedure for Measuring Overall Severity of Psychiatric Disturbance
Endicott, J. (1976) · Archives of General Psychiatry · doi:10.1001/archpsyc.1976.01770060086012 · Cited by 4,982 · see citing works
A quality of life interview for the chronically mentally ill
Lehman, A. F. (1988) · Evaluation and Program Planning · doi:10.1016/0149-7189(88)90033-x · Cited by 1,085 · see citing works
Determinants of Medication Compliance in Schizophrenia: Empirical and Clinical Findings
Fenton, W. S., Blyler, C. R., & HEINSSEN, R. K. (1997) · Schizophrenia Bulletin · doi:10.1093/schbul/23.4.637 · Cited by 944 · see citing works
The Effects of Risperidone on the Five Dimensions of Schizophrenia Derived by Factor Analysis
Marder, S. R., Davis, J. M., & Chouinard, G. (1997) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v58n1205 · Cited by 761 · see citing works
Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001) · Disease Management and Health Outcomes · doi:10.2165/00115677-200109030-00003 · Cited by 614 · see citing works
Randomised controlled trial of compliance therapy
Kemp, R., Kirov, G., Everitt, B. J., Hayward, P., & David, A. S. (1998) · The British Journal of Psychiatry · doi:10.1192/bjp.172.5.413 · Cited by 525 · see citing works
An Analysis of Social Competence in Schizophrenia
Bellack, A. S., Morrison, R. L., Wixted, J. T., & Mueser, K. T. (1990) · The British Journal of Psychiatry · doi:10.1192/bjp.156.6.809 · Cited by 422 · see citing works
Two scales for measuring patients’ perceptions for coercion during mental hospital admission
Gardner, W., Hoge, S. K., Bennett, N., Roth, L. H., Lidz, C. W., Monahan, J., & Mulvey, E. P. (1993) · Behavioral Sciences & the Law · doi:10.1002/bsl.2370110308 · Cited by 342 · see citing works
Swartz, M. S., Swanson, J. W., Wagner, H. R., Burns, B. J., Hiday, V. A., & Borum, R. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.12.1968 · Cited by 337 · see citing works
Self-citationMedication noncompliance and substance abuse among patients with schizophrenia
Owen, R. R., Fischer, E. P., Booth, B. M., & Cuffel, B. J. (1996) · Psychiatric Services · doi:10.1176/ps.47.8.853 · Cited by 330 · see citing works
Measures of quality of life among persons with severe and persistent mental disorders
Lehman, A. F. (1996) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/bf00801903 · Cited by 321 · see citing works
Naber, D. (1995) · International Clinical Psychopharmacology · doi:10.1097/00004850-199509000-00017 · Cited by 309 · see citing works
Swanson, J. W., Swartz, M. S., Wagner, H. R., Burns, B. J., Borum, R., & Hiday, V. A. (2000) · The British Journal of Psychiatry · doi:10.1192/bjp.176.4.324 · Cited by 266 · see citing works
Self-citationDimensions of Outcome with Clozapine
Meltzer, H. Y. (1992) · The British Journal of Psychiatry · doi:10.1192/s000712500029692x · Cited by 251 · see citing works
Smith, T. E., Hull, J. W., Goodman, M. S., Hedayat-Harris, A., Willson, D. F., ISRAEL, L. M., & Munich, R. L. (1999) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199902000-00006 · Cited by 203 · see citing works
Mandated Community Treatment: Beyond Outpatient Commitment
Monahan, J. T., Bonnie, R. J., Appelbaum, P. S., Hyde, P. S., Steadman, H. J., & Swartz, M. S. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.9.1198 · Cited by 199 · see citing works
Self-citationA Randomized Controlled Trial of Outpatient Commitment in North Carolina
Swartz, M. S., Swanson, J. W., Hiday, V. A., Wagner, H. R., Burns, B. J., & Borum, R. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.3.325 · Cited by 189 · see citing works
Self-citationCan Involuntary Outpatient Commitment Reduce Arrests among Persons with Severe Mental Illness?
Swanson, J. W., Borum, R., Swartz, M. S., Hiday, V. A., Wagner, H. R., & Burns, B. J. (2001) · Criminal Justice and Behavior · doi:10.1177/0093854801028002002 · Cited by 158 · see citing works
Self-citationInsight and Interpersonal Function in Schizophrenia
Lysaker, P. H., Bell, M. D., BRYSON, G. J., & Kaplan, E. (1998) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199807000-00008 · Cited by 148 · see citing works
Impact of Outpatient Commitment on Victimization of People With Severe Mental Illness
Hiday, V. A., Swartz, M. S., Swanson, J. W., Borum, R., & Wagner, H. R. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.8.1403 · Cited by 145 · see citing works
Self-citationSwartz, M. S., Swanson, J. W., Hiday, V. A., Borum, R., Wagner, H. R., & Burns, B. J. (1998) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s001270050213 · Cited by 141 · see citing works
Self-citationCorrelates of life satisfaction among psychiatric patients
Koivumaa-Honkanen, H., Viinamäki, H. T., Honkanen, R., Tanskanen, A. J., Antikainen, R., NISKANEN, L. K., Jääskeläinen, J. E., & Lehtonen, J. (1996) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1996.tb09875.x · Cited by 138 · see citing works
Patients’ Revisions of Their Beliefs About the Need for Hospitalization
Gardner, W., Lidz, C. W., Hoge, S. K., Monahan, J., Eisenberg, M. M., Bennett, N. S., Mulvey, E. P., & Roth, L. H. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.9.1385 · Cited by 128 · see citing works
Intervention Research in Psychosis: Issues Related to the Assessment of Quality of Life
Awad, A. G., & Voruganti, L. N. P. (2000) · Schizophrenia Bulletin · doi:10.1093/oxfordjournals.schbul.a033477 · Cited by 118 · see citing works
The ups and downs of oral lithium dosing.
Kilts, C. D. (1998) · PubMed · Cited by 117 · see citing works
Subjective response to neuroleptics and the quality of life: implications for treatment outcome
Awad, A. G., & Hogan, T. P. (1994) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1994.tb05828.x · Cited by 116 · see citing works
Violent behavior preceding hospitalization among persons with severe mental illness.
Swanson, J. W., Borum, R., Swartz, M. S., & Hiday, V. A. (1999) · Law and Human Behavior · doi:10.1023/a:1022320918171 · Cited by 100 · see citing works
Self-citationImpact of Involuntary Outpatient Commitment on the Revolving-Door Syndrome in North Carolina
Fernandez, G. A., & Nygard, S. (1990) · Psychiatric Services · doi:10.1176/ps.41.9.1001 · Cited by 96 · see citing works
Effects of homelessness on the quality of life of persons with severe mental illness
Lehman, A. F., Kernan, E., DeForge, B. R., et al. (1995) · Psychiatric Services · doi:10.1176/ps.46.9.922 · Cited by 95 · see citing works
Novel antipsychotics, extrapyramidal side effects and tardive dyskinesia
Barnes, T. R. E., & McPhillips, M. A. (1998) · International Clinical Psychopharmacology · doi:10.1097/00004850-199803003-00009 · Cited by 86 · see citing works
Swartz, M. S., Swanson, J. W., Wagner, H. R., Burns, B. J., & Hiday, V. A. (2001) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200109000-00003 · Cited by 84 · see citing works
Self-citationSwartz, M. S., Wagner, H. R., Swanson, J. W., Hiday, V. A., & Burns, B. J. (2002) · PubMed · Cited by 77 · see citing works
Self-citationDoes Participation in Psychosocial Treatment Augment the Benefit of Clozapine?
Rosenheck, R. A. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.7.618 · Cited by 73 · see citing works
Opening Pandora's Box: The Practical and Legal Dangers of Involuntary Outpatient Commitment
Allen, M. J., & Smith, V. F. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.3.342 · Cited by 69 · see citing works
Problems of compliance in the outpatient treatment of schizophrenia.
Kane, J. M. (1983) · PubMed · Cited by 68 · see citing works
Housing environments and community adjustment of severely mentally ill persons
Baker, F., & Douglas, C. (1990) · Community Mental Health Journal · doi:10.1007/bf00752454 · Cited by 65 · see citing works
Interpreting the effectiveness of involuntary outpatient commitment: a conceptual model.
Swanson, J. W., Swartz, M. S., George, L. K., Burns, B. J., Hiday, V. A., Borum, R., & Wagner, H. R. (1997) · PubMed · Cited by 57 · see citing works
Self-citationFacilitating compliance with antipsychotic medication.
Marder, S. R. (1998) · PubMed · Cited by 57 · see citing works
Endorsement of personal benefit of outpatient commitment among persons with severe mental illness.
Swartz, M. S., Swanson, J. W., & Monahan, J. T. (2003) · Psychology Public Policy and Law · doi:10.1037/1076-8971.9.1-2.70 · Cited by 52 · see citing works
Self-citationSubjective Experiences of Clozapine Treatment by Patients With Chronic Schizophrenia
Waserman, J., & Criollo, M. (2000) · Psychiatric Services · doi:10.1176/appi.ps.51.5.666 · Cited by 50 · see citing works
Involuntary Outpatient Commitment and Homelessness in Persons with Severe Mental Illness
Compton, S. N., Swanson, J. W., Wagner, H. R., Swartz, M. S., Burns, B. J., & Elbogen, E. B. (2003) · Mental Health Services Research · doi:10.1023/a:1021755408267 · Cited by 31 · see citing works
Self-citationRehabilitation Programmes and Quality of Life in Severe Mental Illness
Browne, S. (1999) · International Journal of Social Psychiatry · doi:10.1177/002076409904500409 · Cited by 29 · see citing works
Does involuntary outpatient commitment lead to more intensive treatment?
Wagner, H. R., Swartz, M. S., Swanson, J. W., & Burns, B. J. (2003) · Psychology Public Policy and Law · doi:10.1037/1076-8971.9.1-2.145 · Cited by 26 · see citing works
Self-citationTarrier, N., & Bobes, J. (2000) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651500050518028 · Cited by 25 · see citing works
Multiple-outcome criteria in schizophrenia: an overview of outcome with clozapine
Meltzer, H. (1995) · European Psychiatry · doi:10.1016/0767-399x(96)80080-0 · Cited by 25 · see citing works
Preventive Commitment: The Concept and Its Pitfalls
Stefan, S. (2016) · DigitalGeorgetown (Georgetown University Library) · Cited by 19 · see citing works
CCPP-Copenhagen Community Psychiatric Project
Nordentoft, M., Welcher, B., Knudsen, H. C., Krasnik, A., Jessen-Petersen, B., Treufeldt, P., & S�lan, H. (1996) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/bf00783422 · Cited by 19 · see citing works
Does Outreach Case Management Improve Patients' Quality of Life?
Curtis, J. L., Millman, E. J., Struening, E. L., & D'Ercole, A. (1998) · Psychiatric Services · doi:10.1176/ps.49.3.351 · Cited by 18 · see citing works
Byrne, C., Brown, B., Voorberg, N., et al. (1999) · Psychiatric Rehabilitation Journal · doi:10.1037/h0095213 · Cited by 18 · see citing works
Skinner, E. A., Steinwachs, D. M., Handley, K., et al. (1999) · Mental Health Services Research · doi:10.1023/a:1022594320569 · Cited by 16 · see citing works
The psychiatric hospital and therapeutic jurisprudence: Applying the law to promote mental health
Elbogen, E. B., & Tomkins, A. J. (1999) · New Directions for Mental Health Services · doi:10.1002/yd.23319998408 · Cited by 8 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Stigma and coercion in the context of outpatient treatment for people with mental illnesses
Link, B., Castille, D. M., & Stuber, J. (2008) · Social Science & Medicine · doi:10.1016/j.socscimed.2008.03.015 · Cited by 233 · see citing works
Compulsory community and involuntary outpatient treatment for people with severe mental disorders.
Kisely, S. R., Campbell, L. A., & O'Reilly, R. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004408.pub5 · Cited by 123 · see citing works
Assessing outcomes for consumers in New York's assisted outpatient treatment program
Swartz, M. S., Wilder, C. M., Swanson, J. W., Van Dorn, R. A., Robbins, P. C., Steadman, H. J., Moser, L. L., Gilbert, A. R., & Monahan, J. (2010) · Psychiatric Services · doi:10.1176/ps.2010.61.10.976 · Cited by 120 · see citing works
Coercion in psychiatric care: Systematic review of correlates and themes
Newton-Howes, G., & Mullen, R. (2011) · Psychiatric Services · doi:10.1176/ps.62.5.pss6205_0465 · Cited by 114 · see citing works
Effectiveness and outcomes of assisted outpatient treatment in New York State
Phelan, J. C., Sinkewicz, M., Castille, D. M., Huz, S., & Link, B. G. (2010) · Psychiatric Services · doi:10.1176/ps.2010.61.2.137 · Cited by 84 · see citing works
Jaeger, M., & Rossler, W. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2009.09.011 · Cited by 77 · see citing works
Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review
Lessard-Deschênes, C., Pariseau-Legault, P., Billé, V., Sergerie-Richard, S., Hudson, E., Silva, B., Drouin, J.-S., Désilets, M., & Goulet, M.-H. (2025) · Healthcare · doi:10.3390/healthcare13151868 · Cited by 10 · see citing works
Perceived Coercion of Persons with Mental Illness Living in a Community
Lee, M. H., & Seo, M. K. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18052290 · Cited by 7 · see citing works
- Authors
- Swanson, J. W., Swartz, M. S., Elbogen, E. B., Wagner, H. R., & Burns, B. J.
- Affiliations
- Duke University (US)
- Corresponding author
- Swanson, Jeffrey W.
- Venue
- Behavioral Sciences & the Law
- Publisher
- Wiley
- Published
- 2003-07
- Volume
- 21
- Issue
- 4
- Pages
- 473-491
- ISSN
- 0735-3936 (ISSN-L)
- 1099-0798
- OpenAlex
- W2006196101
- Cited by
- 107
- References
- 52
- Citations by year
- 2025: 5 · 2024: 1 · 2023: 4 · 2022: 19 · 2021: 2 · 2020: 5 · 2019: 6 · 2018: 1 · 2017: 3 · 2016: 5 · 2015: 2 · 2014: 4 · 2012: 3
- FWCI
- 6.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavioral Sciences & the Law (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh048103-08, 5p50mh051410-05)
- National Institute of Mental Health (P50-MH51410-02, R01-MH48103-05)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- involuntary outpatient commitment, subjective quality of life, severe mental illness, medication adherence, perceived coercion, psychiatric hospitalization, symptom severity, community reintegration
- MeSH terms
- Adult, Mental Disorders, Coercion, Commitment of Persons with Psychiatric Disorders, Community Mental Health Services, Female, Ill-Housed Persons, Humans, Male, Patient Compliance, Quality of Life, Severity of Illness Index, United States, Violence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
