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Assessing the New York City Involuntary Outpatient Commitment Pilot Program
Abstract
OBJECTIVE: The study evaluated the effectiveness of a three-year outpatient commitment pilot program established in 1994 at Bellevue Hospital in New York City. METHODS: A total of 142 participants were randomly assigned; 78 received court-ordered treatment, which included enhanced services, and 64 received the enhanced-service package only. Between 57 and 68 percent of the subjects completed interviews at one, five, and 11 months after hospital discharge. Outcome measures included rehospitalization, arrest, quality of life, symptomatology, treatment noncompliance, and perceived level of coercion. RESULTS: On all major outcome measures, no statistically significant differences were found between the two groups. No subject was arrested for a violent crime. Eighteen percent of the court-ordered group and 16 percent of the control group were arrested at least once. The percentage rehospitalized during follow-up was about the same for both groups-51 percent and 42 percent, respectively. The groups did not differ significantly in the total number of days hospitalized during the follow-up period. Participants' perceptions of their quality of life and level of coercion were about the same. From the community service providers' perspective, patients in the two groups were similarly adherent to their required treatments. CONCLUSIONS: All results must be qualified by the fact that no pick-up order procedures for noncompliant subjects in the court-ordered group were implemented during the study, which compromised the differences between the conditions for the two groups, and that persons with a history of violence were excluded from the program.
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In the citing paper
“Two studies did not mentioned blinding (Swartz 1999; Steadman 2001).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“Two of the studies were identified in the original search of 2003 (Swartz 1999; Steadman 2001) and the third in the 2014 search (Burns 2013).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“We included three studies involving 749 participants: two studies from the USA comparing OPC with entirely voluntary treatment (Swartz 1999; Steadman 2001), and one UK study, the Oxford Community Treatment Order Evaluation Trial (OCTET), comparing two types of CCT interspaced with voluntary care (Burns 2013).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“There was no clear difference between people allocated to CTOs and controls (RR 1.87, 95% CI 0.87 to 4.01, Analysis 1.3).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“Similarly, the authors of the Steadman 2001 study supplied the additional data for an intention-to-treat analysis of their paper (67 people in the controls, 85 in the OPC group).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“However, the inclusion of data from Steadman 2001 did not alter the overall effect and so we added them to data from Swartz 1999.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“In both cases, there was no clear difference between allocation to CTO and controls at follow-up. It was only possible to impute SDs for the GAF scores (MD -3.00, 95% CI -8.08 to 2.08, Analysis 1.5).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“This showed that participants on CCT did not feel more coerced that participants in the control group at 11 to 12 months (RR 1.30, 95% CI 0.98 to 1.71, Analysis 3.5).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“There was no clear difference between participants on CTOs and controls in readmission to hospital by 12 months (RR 0.98, 95% CI 0.83 to 1.17, Analysis 3.1).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“At follow-up, there was no difference between people allocated to CTOs and controls in global state (GAF) (MD -1.36 95% CI -4.07 to 1.35, Analysis 3.4).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“In the case of the New York study (Steadman 2001), there was a relatively small number of participants”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“Finally, we studied the effect of including admissions to both acute facilities and state hospitals for people allocated to CTOs (49/85) and controls (42/67) in the New York study (Steadman 2001). This made no difference to the results (3 RCTs, n = 749, RR 0.93, 95% CI 0.80 to 1.09).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“There was no clear (statistical) difference in the number of people who required more than one readmission by 12 months (RR 1.02, 95% CI 0.31 to 3.33, Analysis 3.3).”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“Random sequence genera- tion (selection bias) | Low risk | The study used a random number list to identify assignment to either the in- tervention or control group. Random number list was generated by computer, which then split 200 numbers between groups.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“Other bias | Unclear risk | Unclear, no conflict of interests reported. The New York Police did not bring people for assessment when they breached their treatment orders. Therefore, there was no consequence to the order as intended by the law.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“Selective reporting (re- porting bias) | Unclear risk | Unclear from paper.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“Blinding (performance bias and detection bias) All outcomes | High risk | No specific mention in the study. Although self-report measures were used for at least some of the outcomes, it was unlikely participants, clinicians or asses- sors were blind to treatment status. There was also confusion that resulted in some control participants and their clinicians believing that they were in”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“10 Participant level outcomes: 6. Satisfaction with care: perceived coercion by 11 to 12 months | 2 | 416 | Risk Ratio (M-H, Fixed, 95% CI) | 1.36 [0.97, 1.89]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“Allocation concealment (selection bias) | Unclear risk | Unclear. The printed list was maintained in the research team's office in a locked file. When the treatment team had completed their treatment plan, they called the research team who checked the computer list to see whether the client was to be assigned to the experimental or comparison group.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“6.1 at least 1 arrest | 2 | 416 | Risk Ratio (M-H, Fixed, 95% CI) | 0.97 [0.62, 1.52]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“| Steadman 2001 | 19/85 | 8/67 | | | 100% | 1.87[0.87,4.01] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“1 Health service outcomes: 1. Readmission to hospi- tal - by 11 to 12 months | 2 | 416 | Risk Ratio (M-H, Fixed, 95% CI) | 0.98 [0.79, 1.21]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“Incomplete outcome data (attrition bias) All outcomes | High risk | Only 57% to 68% of the participants completed interviews at 1, 5 and 11 months after hospital discharge. Only some outcomes were assessed by ITT analysis.”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“4 Health service outcomes: 4. Compliance with med- ication by 11 to 12 months | 2 | 416 | Risk Ratio (M-H, Fixed, 95% CI) | 0.99 [0.83, 1.19]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“| Subtotal (95% CI) | 214 | 202 | | 100% | 0.97[0.62,1.52] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“| Steadman 2001 | 58 | 44 (12) | 40 | 47 (13) | | | 100% | -3[-8.08,2.08] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“6.2 ever arrested/picked up by police for violence against a person | 2 | 416 | Risk Ratio (M-H, Fixed, 95% CI) | 0.82 [0.56, 1.21]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“8 Participant level outcomes: 4. Quality of life: Lehman Quality of Life Scale | 2 | 406 | Mean Difference (IV, Random, 95% CI) | -0.22 [-0.95, 0.50]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“7 Participant level outcomes: 3. Social functioning: homeless by 11 to 12 months | 2 | 416 | Risk Ratio (M-H, Fixed, 95% CI) | 0.67 [0.39, 1.15]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“3 Health service outcomes: 3. Number with multiple readmissions by 12 months | 1 | 152 | Risk Ratio (M-H, Fixed, 95% CI) | 1.87 [0.87, 4.01]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“5 Participant level outcomes: 2. Satisfaction with care: perceived coercion or leverage at 11 to 12 months | 3 | 645 | Risk Ratio (M-H, Fixed, 95% CI) | 1.30 [0.98, 1.71]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“3 Health service outcomes: 3. Number with multiple readmissions by 12 months | 2 | 485 | Risk Ratio (M-H, Random, 95% CI) | 1.02 [0.31, 3.33]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“4 Participant level outcomes: 1. global state: GAF at 12 months | 2 | 335 | Mean Difference (IV, Fixed, 95% CI) | -1.36 [-4.07, 1.35]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“1 Health service outcomes: 1. Readmission to hospi- tal by 11 to 12 months | 3 | 749 | Risk Ratio (M-H, Fixed, 95% CI) | 0.98 [0.83, 1.17]”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“| Total (95% CI) | 214 | 202 | | 100% | 0.67[0.39,1.15] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“| Total *** | 207 | | 199 | | | 100% | -0.22[-0.95,0.5] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“| Total (95% CI) | 214 | 202 | | 100% | 1.36[0.97,1.89] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“| Subtotal (95% CI) | 214 | 202 | | 100% | 0.82[0.56,1.21] |”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
In the citing paper
“the New York study reported attrition rates of approximately 45% for 11-month outcomes (Steadman 2001)”
From Compulsory community and involuntary outpatient treatment for people with severe mental disorders. (2017) · cites this paper as Steadman 2001
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Metadata
- Authors
- Steadman, H. J., Gounis, K., Dennis, D., Hopper, K., Roche, B., Swartz, M., & Robbins, P. C.
- Affiliations
- Policy Research Associates (US)
- Venue
- Psychiatric Services
- Published
- 2001-03
- Volume
- 52
- Issue
- 3
- Pages
- 330-336
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W2096409461
- Cited by
- 312
- References
- 17
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 3 · 2023: 5 · 2022: 5 · 2021: 6 · 2020: 9 · 2019: 13 · 2018: 21 · 2017: 15 · 2016: 19 · 2015: 12 · 2014: 24 · 2013: 24 · 2012: 8
- FWCI
- 21.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- 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, court-ordered treatment, mental health services, hospital readmission, arrests, quality of life, treatment non-adherence, perceived coercion, community service providers, pilot program evaluation, New York City
- MeSH terms
- Adult, Coercion, Commitment of Persons with Psychiatric Disorders, Community Mental Health Services, Crime, Female, Hospitals, Psychiatric, Humans, Male, Middle Aged, New York City, Patient Readmission, Pilot Projects, Psychotic Disorders, Quality of Life, Program Evaluation, Treatment Refusal, Outcome Assessment, Health Care
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