Effectiveness and outcomes of assisted outpatient treatment in New York State

Phelan, Jo C.; Sinkewicz, Marilyn; Castille, Dorothy M.; Huz, Steven; Link, Bruce G.

doi:10.1176/ps.2010.61.2.137

Cited by 84Healthcare Decision-Making and RestraintsPsychiatric care and mental health servicesSchizophrenia research and treatment

Effectiveness and outcomes of assisted outpatient treatment in New York State

Phelan, Jo C., Sinkewicz, Marilyn, Castille, Dorothy M., Huz, Steven, Link, Bruce G.·2010·Psychiatric Services

DOI 10.1176/ps.2010.61.2.137

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Abstract

OBJECTIVE: Outpatient commitment has been heralded as a necessary intervention that improves psychiatric outcomes and quality of life, and it has been criticized on the grounds that effective treatment must be voluntary and that outpatient commitment has negative unintended consequences. Because few methodologically strong data exist, this study evaluated New York State's outpatient commitment program with the objective of augmenting the existing literature. METHODS: A total of 76 individuals recently mandated to outpatient commitment and 108 individuals (comparison group) recently discharged from psychiatric hospitals in the Bronx and Queens who were attending the same outpatient facilities as the group mandated to outpatient commitment were followed for one year and compared in regard to psychotic symptoms, suicide risk, serious violence perpetration, quality of life, illness-related social functioning, and perceived coercion and stigma. Propensity score matching and generalized estimating equations were used to achieve the strongest causal inference possible without an experimental design. RESULTS: Serious violence perpetration and suicide risk were lower and illness-related social functioning was higher (p<.05 for all) in the outpatient commitment group than in the comparison group. Psychotic symptoms and quality of life did not differ significantly between the two groups. Potential unintended consequences were not evident: the outpatient commitment group reported marginally less (p<.10) stigma and coercion than the comparison group. CONCLUSIONS: Outpatient commitment in New York State affects many lives; therefore, it is reassuring that negative consequences were not observed. Rather, people's lives seem modestly improved by outpatient commitment. However, because outpatient commitment included treatment and other enhancements, these findings should be interpreted in terms of the overall impact of outpatient commitment, not of legal coercion per se. As such, the results do not support the expansion of coercion in psychiatric treatment.

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Seclusion and restraints were reported as highly distressing, with patients likening them to hell or prison and stating they worsened their condition.
“Seclusion and restraints were reported as highly distressing, with patients likening them to hell or prison and stating they worsened their condition [81].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [81]
Patients with a history of involuntary admission reported higher perceived coercion.
“Additionally, patients with a history of involuntary admission reported higher perceived coercion [14,74,75,81,89,98,131]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [81]

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Authors: Phelan, J. C., Sinkewicz, M., Castille, D. M., Huz, S., & Link, B. G.
Affiliations: Columbia University (US)
ORCID: Phelan, Jo C.
Link, Bruce G.
Venue: Psychiatric Services
Publisher: American Psychiatric Association Publishing
Published: 2010-02
Volume: 61
Issue: 2
Pages: 137-143
ISSN: 0022-1597 (ISSN-L)
1075-2730
1557-9700
DOI: 10.1176/ps.2010.61.2.137
OpenAlex: W1969710454
Cited by: 84
References: 25
Citations by year: 2026: 2 · 2025: 6 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 7 · 2017: 1 · 2016: 5 · 2015: 14 · 2014: 6 · 2013: 5 · 2012: 7
FWCI: 9.81
Type: journal article
Language: en
Open access: closed
Locations: Psychiatric Services (publishedVersion)
PubMed (publishedVersion)
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: outpatient commitment, coercion in mental health care, suicide risk, psychotic symptoms, quality of life, stigma, psychiatric hospital discharge
MeSH terms: Suicide Prevention, Adult, Ambulatory Care, Antisocial Personality Disorder, Mental Disorders, Coercion, Commitment of Persons with Psychiatric Disorders, Community Mental Health Centers, Female, Follow-Up Studies, Humans, Male, Middle Aged, New York, Outcome and Process Assessment, Health Care, Patient Discharge, Prejudice, Psychotic Disorders, Quality of Life, Social Adjustment, Suicide, Urban Population, Violence, Patient Satisfaction, Case Management

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