RAND Study: Effectiveness of Involuntary Outpatient Treatment is Unclear

After AB 1800, which would have broadened California law regarding involuntary treatment, passed the Assembly but was stopped in the Senate last year, the Senate Rules Committee commissioned a study by RAND to investigate whether involuntary outpatient treatment works, how it has been implemented in other states, and how such an approach would affect people with severe mental illness in California.   

The RAND study team reviewed the available studies, interviewed stakeholders in eight states that have involuntary outpatient treatment systems, and analyzed administrative data on services provided by California’s county mental health programs.  

The RAND study was hampered by several problems: there are only two recent studies which were based on randomized clinical trials and these reached conflicting conclusions; the New York study found no significant impact, but the Duke study suggested that outcomes were improved.  In contrast the literature provides clear evidence that intensive community-based treatment programs, can produce good outcomes for people with severe mental illness.  There have been no randomized clinical trials comparing the relative effectiveness of involuntary outpatient treatment and assertive community treatment programs, so there is no empirical evidence that a court order is necessary to assure good outcomes.   

Another problem was the California client service data available for analysis:  admissions data from hospitals that counties contract with under the Medi-Cal Inpatient Consolidation are not included; and the data is primarily for administrative use, so the researchers could not ascertain whether the significant percentage of people who were hospitalized more than once during the study year and who received no outpatient services during the same period did not use community based services because of non-compliance with treatment plans or because of problems in accessing these services or both. 

The RAND study noted that a significant percentage of Californians with mental illness who need services aren’t getting them and those who do get service don’t get much.  The authors also observed that if California seeks to make a significant improvement in its mental health service system, whether through developing involuntary outpatient treatment systems or by providing up to date and accessible community based services, the effort will require a sustained administrative and financial commitment by state government.  

One of the report's main conclusions was that California's mental health system is underfunded.

The RAND study is available at www.rand.org/MR/MR1340.
- The Families Advocate Newsletter of NAMI Alameda County  

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