Mental health has long been a signature issue for the MacArthur Foundation. Accordingly, in December 2000, the Board approved a Phase I planning proposal for an Initiative on Mandated Community Treatment to address the involuntary treatment of people with mental disorder in the community. John Monahan directs the Initiative, and Richard Bonnie is one of its twelve members.
Much of the strident policy debate on outpatient commitment treats it as if it were simply an extension of inpatient commitment. In fact, however, outpatient commitment is only one of a growing array of legal tools used to mandate treatment adherence in the community. The purpose of this Initiative is to elaborate a new and broader conceptual framework to encompass all forms of mandated community treatment.
Studies in five areas are needed: People with severe and chronic mental disorders are often dependent upon goods and services provided by the social welfare system. Benefits disbursed by representative payees and the provision of subsidized housing have both been used as leverage to assure treatment adherence. Similarly, many discharged patients find themselves arrested for criminal offenses. Favorable disposition of their cases by a newly-created mental health court may be tied to treatment participation. In addition, under outpatient commitment statutes, judges have the authority to order committed patients to comply with prescribed treatment. In response, a patient may attempt to maximize his or her own control over treatment in the event of later deterioration by executing an advance directive.
If mental health law and policy are to incorporate -- or to repudiate -- some or all of these types of leverage, an evidence-based approach must rapidly come to replace the ideological posturing that currently characterizes the field.
For more information, please visit the MacArthur Research Network's home page at www.macarthur.virginia.edu/mentalhome.html.