Some have clinically justified mandated treatment mechanisms for persons with serious mental illness (SMI) on the basis that persons with SMI benefit from mandated care because coercion compensates for psychosocial deficits. However, services research on systematic coercive measures, such as outpatient commitment, has not examined this assumption. The Investigators propose a prospective naturalistic study of formal mandates to receive community mental health services. Mandates to comply with treatment are found in outpatient commitment, probation and parole, housing services, child protection services, substance abuse treatment, crisis services, and homeless services (Mulvey, Geller, & Roth, 1987). These formal mandates can vary in nature and intensity. However, ambiguity about the extent to which such mandates result in receipt of effective services confounds interpretation of research on policies such as outpatient commitment, intensive case management or intensive probation for persons with mental illness. Attribution of client outcomes, such as reduced hospital recidivism, to service mandates has been hampered by the vague treatment of potentially important variables such as perceived and objective coercion, working alliance with enforcing clinicians, and serious mental illness (SMI) (Draine, in press; Maloy, 1996). A sample of 250 individuals will be followed from acute inpatient hospitalization, through 90 day commitments to aftercare, and 90 days after the termination of the commitment period to test an outcome model of coercion in the context of mandated services.
| Wilson, Amy Blank; Barrenger, Stacey; Bohrman, Casey et al. (2013) Balancing accessibility and selectivity in 21st century public mental health services: implications for hard to engage clients. J Behav Health Serv Res 40:191-206 |
