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Last updated
2005.07.17.

The presumed link between mental disorder and violence has been the driving force behind mental health law and policy for centuries. Legislatures, courts, and the public have come to expect that psychologists and other mental health professionals will protect them from violent acts by persons with mental disorders. An intense policy debate is now occurring in many countries on the legitimacy of laws ordering people with mental disorder to accept outpatient mental health treatment. Much of this debate on “outpatient commitment” assumes that court-ordered treatment in the community is simply an extension of policies authorizing involuntary commitment as a hospital inpatient. In fact, however, outpatient commitment is only one of a growing array of tools used to mandate adherence to mental health treatment in community settings, ostensibly on the grounds of violence risk reduction.

People with severe and chronic mental disorders are often dependent upon goods and services provided by the social welfare system. Benefits disbursed by money managers and the provision of subsidized housing have both been used as leverage to assure treatment adherence in the community. Similarly, many people with mental disorder become involved with one or another aspect of the judicial system. For people who commit a criminal offense, adherence to mental health treatment may be made a condition of probation. Favorable disposition of their cases by a newly-created mental health court may also be tied to treatment participation. In addition, under some outpatient commitment statutes, judges have the authority to order committed patients to comply with prescribed treatment in the community, even if the patient does not meet the usual legal standards for treatment in a hospital.

If mental health law and policy are to incorporate—or to repudiate—some or all of these types of leverage in the community, an evidence-based approach must become an integral part of policy deliberations. Evidence from two projects funded in the U.S. by the MacArthur Foundation—the Research Network on Mental Health and the Law, and the Research Network on Mandated Community Treatment—will be used to illustrate these points.