Non-compliance with treatment continues to be a major cause of relapse, rehospitalization, decreased functioning and other poor outcomes among the seriously mentally ill. Efforts to identify causes of and remedies for non-compliance have stimulated a wide range of clinical investigative efforts. One promising approach to reducing non-compliance is court- mandated outpatient treatment referred to as involuntary outpatient commitment (OPC). All states have made provisions for outpatient commitment in the belief that OPC will improve compliance and treatment outcomes. In practice, OPC may serve as a stimulus to mobilize resources for more aggressive treatment efforts. A number of studies have demonstrated that OPC reduces rates of rehospitalization and improves other outcomes; but findings are mixed, due in part to variability in service provision. No studies have examined the extent to which OPC affects compliance and treatment outcomes when essential services are consistently measured nor have studies controlled for selection effects and other important confounds. The proposed study examines the effects of OPC on compliance and treatment outcomes net of service system mobilization in a randomized clinical trial of OPC combined with community-based case management and will seek to eliminate previous sources of bias in studies of OPC. Involuntarily admitted patients meeting criteria for severe and persistent mental illness and legal criteria for OPC will be randomly assigned to one of two treatment conditions: OPC plus case management or case management alone. Both groups will include similar proportions of black and rural patients. Outcomes of primary interest are: rehospitalization and length of stay, and time until rehospitalization. Other outcomes include psychiatric symptoms, functioning, quality of life, family burden, dangerousness, arrests and jail time. In addition to the specific program announcements, Effectiveness and Outcomes of Mental Health Services and Research on Mental Health Services in Rural Areas, this study addresses the program priorities of the Public-Academic Liaison Initiative and is responsive to the Legal Issues Section of the Service Systems Research Panel Report developed for the NIMH National Plan of Research to Improve Care for Severe Mental Disorders.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH048103-04
Application #
2247961
Study Section
Special Emphasis Panel (SRCM (01))
Project Start
1992-06-01
Project End
1997-05-31
Budget Start
1995-06-01
Budget End
1996-05-31
Support Year
4
Fiscal Year
1995
Total Cost
Indirect Cost
Name
Duke University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
071723621
City
Durham
State
NC
Country
United States
Zip Code
27705
Lu, Weili; Mueser, Kim T; Rosenberg, Stanley D et al. (2008) Correlates of adverse childhood experiences among adults with severe mood disorders. Psychiatr Serv 59:1018-26
Elbogen, Eric B; Beckham, Jean C; Butterfield, Marian I et al. (2008) Assessing risk of violent behavior among veterans with severe mental illness. J Trauma Stress 21:113-7
Thompson, Maxine Seaborn (2007) Violence and the costs of caring for a family member with severe mental illness. J Health Soc Behav 48:318-33
Rosenberg, Stanley D; Lu, Weili; Mueser, Kim T et al. (2007) Correlates of adverse childhood events among adults with schizophrenia spectrum disorders. Psychiatr Serv 58:245-53
Elbogen, Eric B; Swanson, Jeffrey W; Swartz, Marvin S et al. (2005) Family representative payeeship and violence risk in severe mental illness. Law Hum Behav 29:563-74
Van Dorn, Richard A; Swanson, Jeffrey W; Elbogen, Eric B et al. (2005) A comparison of stigmatizing attitudes toward persons with schizophrenia in four stakeholder groups: perceived likelihood of violence and desire for social distance. Psychiatry 68:152-63
Rosenberg, Stanley D; Drake, Robert E; Brunette, Mary F et al. (2005) Hepatitis C virus and HIV co-infection in people with severe mental illness and substance use disorders. AIDS 19 Suppl 3:S26-33
Elbogen, Eric B; Swanson, Jeffrey W; Swartz, Marvin S et al. (2005) Medication nonadherence and substance abuse in psychotic disorders: impact of depressive symptoms and social stability. J Nerv Ment Dis 193:673-9
Swartz, Marvin S; Swanson, Jeffrey W (2004) Involuntary outpatient commitment, community treatment orders, and assisted outpatient treatment: what's in the data? Can J Psychiatry 49:585-91
Mueser, Kim T; Salyers, Michelle P; Rosenberg, Stanley D et al. (2004) Interpersonal trauma and posttraumatic stress disorder in patients with severe mental illness: demographic, clinical, and health correlates. Schizophr Bull 30:45-57

Showing the most recent 10 out of 47 publications