Outpatient Commitment for Adults with Psychiatric Disabilities: Examining the Underlying Assumptions

Abstract

Outpatient commitment laws have been proposed as one way to increase service utilization among adults with psychiatric disabilities. While these laws vary from state to state, they are linked by a common set of assumptions about mental health consumers and services. Due to special circumstances surrounding its passage, New York's Assisted Outpatient Treatment Act (AOT) provides an excellent opportunity to examine these assumptions. It is argued that AOT is founded on the following assumptions: Mental health consumers are by definition not competent to direct their recovery; the decision not to use formal mental health services is a symptom of the disability and evidence of poor insight; the best intervention for psychiatric disability is a primarily medical one; and mental health services are universally and consistently helpful. Based on a critique of these assumptions, the author recommends that future research on this and other outpatient commitment policies focus on the consumer experience. In addition, future policies should be designed around a consideration of mental health consumers as a resilient, rather than vulnerable, population. Social workers are urged to apply these arguments to their practice and advocacy.