Public Education & Policy :: Position Papers

What Recent Reports Say About Involuntary Outpatient Commitment and the Expansion of Forced Treatment

You may have heard that involuntary outpatient commitment has been proven to be effective. You may also have heard that involuntary outpatient commitment and changing the commitment laws to expand forced treatment are necessary to provide needed services to people with mental disabilities. Two recent California reports challenge these conclusions.

What the Little Hoover Commission said on changing the commitment laws to make it easier to forcibly treat people with mental disabilities.

The Little Hoover Commission, an independent state oversight agency, in Being There: Making a Commitment to Mental Health , November 2000, on the reform of the Lanterman, Petris, Short (LPS) law (California's involuntary treatment law.):

The Commission believes that adequate information has not been developed to fully assess the need for LPS Reform. Involuntary treatment laws may need to be reformed. But involuntary treatment should be understood as the last and final resort in a continuum of care that prioritizes voluntary treatment. The Commission believes the debate over LPS reform should be guided by the following analysis:

• An assessment of how the current LPS law is administered across counties. Are due process requirements adequate and involuntary treatment decisions consistent across the state?
• An assessment of how improved access to voluntary treatment could diminish the need for involuntary treatment. The State should ensure that involuntary treatment is only an option when no other form of treatment is effective. Inadequate access to voluntary care does not warrant the use of involuntary care.
• The dimensions of the problem that LPS reform would address. Preliminary data suggest the rate of involuntary commitment is increasing; it is unclear why. How has the use of involuntary commitment changed over time? How does the law affect different ethnic groups? How would a reformed law change outcomes?
• The capacity of state and local authorities to better serve existing clients through other "involuntary" models, such as CONREP, mental health courts, or probation.
• The ability of the State to improve the quality of involuntary care and decrease the level of fear clients associate with forced treatment.

"California's involuntary commitment law - the LPS act - is one of the most controversial mental health issues of the day. But the Commission found the most important and immediate concern to be the 1.5 million Californians who need help, but do not receive it." Being There: Making a Commitment to Mental Health, Executive Summary.

What RAND said on the Effectiveness of Involuntary Outpatient Treatment

RAND was commissioned by the California Senate Committee on Rules to develop a report on involuntary outpatient commitment. The Effectiveness of Involuntary Outpatient Treatment, Empirical Evidence and the Experience of Eight State, 2001.

• The data is inconclusive on whether involuntary outpatient commitment works.
  
  "There is no evidence that a court order is necessary to achieve compliance and good outcomes ..."
  
  
• The literature provides clear evidence that "alternative community based mental health treatments can produce good outcomes for people with severe mental illness."
  
  
• "The data suggest that a significant percentage of people with mental illness who need services aren't getting them, and those who do get very few."
  
  

Prepared by the California Network of Mental health Clients

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