Preventing psychiatric hospitalization and involuntary outpatient commitment. 2009

Steven P Segal, and Philip Burgess
Mental Health and Social Welfare Research Group, University of California at Berkeley, Berkeley, California, USA. spsegal@berkeley.edu

Over the course of a decade in Victoria, Australia, this study considered how, for whom, under what circumstances, and with what consequences for a patient's treatment career involuntary outpatient commitment was used to prevent psychiatric hospitalization. Records were obtained from the Victorian Psychiatric Case Register for patients with career hospitalizations, 8,879 exposed to outpatient orders. Descriptive statistics and logistic regression were used to determine the characteristics of patients solely selected for placement on orders directly from the community, in lieu of re-hospitalization, versus patients selected for placement on orders only from the hospital or for those who experienced both hospital and community-initiated orders. Ordinary least squares regression was used to evaluate the relationship of sole reliance on community-initiated orders and experienced changes in future hospital utilization. Outpatient orders were infrequently issued directly from the community by comparison with orders issued at termination of inpatient episodes. Patients whose placements on orders were carried out only through direct community placement differed from those whose placement was primarily initiated from hospital or from both hospital and community. The former group, while largely comprised of people with schizophrenia, was less likely to include such patients than the comparison samples. It also included fewer males and "never married" individuals as well as more individuals with major affective disorders. Those served solely with community-initiated orders showed significantly less use of subsequent inpatient care than individuals in the comparison samples, all other diagnostic and pre-morbid adjustment characteristics taken into account. For patients at risk of beginning a career of long-term psychiatric hospitalization, sole reliance on community-initiated orders appeared to prevent additional hospital involvement. The issuance of orders from hospital and the combined-order strategy were associated with protective oversight throughout extended inpatient careers. Sole reliance on community-initiated outpatient orders provided a "least restrictive" alternative to hospitalization.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D012042 Registries The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. Parish Registers,Population Register,Parish Register,Population Registers,Register, Parish,Register, Population,Registers, Parish,Registers, Population,Registry
D003134 Commitment of Mentally Ill Legal process required for the institutionalization of a patient with severe mental problems. Outpatient Commitment,Commitment, Outpatient,Mentally Ill Commitments
D005260 Female Females
D006760 Hospitalization The confinement of a patient in a hospital. Hospitalizations
D006778 Hospitals, Psychiatric Special hospitals which provide care to the mentally ill patient. Mental Hospitals,Hospitals, Mental,Mental Institutions,Psychiatric Hospitals,Hospital, Mental,Hospital, Psychiatric,Institution, Mental,Institutions, Mental,Mental Hospital,Mental Institution,Psychiatric Hospital
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D014739 Victoria A state in southeastern Australia, the southernmost state. Its capital is Melbourne. It was discovered in 1770 by Captain Cook and first settled by immigrants from Tasmania. In 1851 it was separated from New South Wales as a separate colony. Self-government was introduced in 1851; it became a state in 1901. It was named for Queen Victoria in 1851. (From Webster's New Geographical Dictionary, 1988, p1295 & Room, Brewer's Dictionary of Names, p574)

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