TAC Statement on Bellevue Outpatient Commitment Program

Bellevue Program Successfully Reduces Hospitalization for Individuals With Severe Psychiatric Disorders

ARLINGTON, VA  A pilot outpatient commitment (OPC) program at Bellevue Hospital again demonstrates that intensive outpatient services coupled with court ordered treatment work to reduce hospital stays for individuals with severe mental illnesses, such as schizophrenia and manic depressive disorder. In OPC, a court mandates treatment (usually including medication) for individuals who suffer from severe mental illnesses who have a history of medication non-compliance in the community. A new study of the Bellevue OPC program revealed that individuals who received court orders for treatment in addition to enhanced community services spent 57 percent less time in psychiatric hospitals than individuals who had enhanced services alone without a court order. That is, those who did not have court ordered treatment spent 14 weeks in the hospital, compared to six weeks for those who did have a court order.

        Mel Silverman, a member of Rockland County’s NAMI-FAMILYA, whose 43-year-old son is in the Bellevue program, said, “My son is doing better now than he ever has during the last 23 years of his illness.” Silverman’s son graduated magna sum laude from Cornell University before being diagnosed with manic-depressive disorder. According to Mr. Silverman, “You name the hospital in the New York City Metro area and he has been in it. My son is now on an even-keel for the first time in a long time thanks to this program.”

        Silverman’s son has benefited from a court order for treatment, coupled with services provided by his assertive community treatment (ACT) team, which is an intensive clinical outreach team. The combination of the court order and the ACT team is an effective means of ensuring that he continues the treatment that keep him well.

        New York is one of the last states to implement OPC even though it has been shown repeatedly to  be effective in other states. In Washington, D.C., admissions decreased from 1.81 per year to 0.95 per year before and after outpatient commitment; in Ohio the decrease was from 1.5 to 0.4; and in Iowa from 1.3 to 0.3. In North Carolina, admissions for patients on outpatient commitment decreased from 3.7 to 0.7 per 1,000 days. Another study in North Carolina demonstrated fewer psychiatric admissions and shorter lengths of stay for patients who received case management services enhanced by a court order (admissions - 0.34 per patient and length of stay 6.9 days) than for individuals who received case management without a court order.

        An equally important finding from the study of the Bellevue OPC program is that the enhanced community services that all participants received were effective in reducing rehospitalization rates overall (for individuals with court orders the rate dropped from 87.1 percent to 51.4 percent; for those who did not have orders the rate dropped from 80.1 percent to 41.6 percent).

        Another important, yet unexpected finding is that there was no reported difference in the perception of coercion between the court ordered and non-court ordered participants in the program.  This is significant because it dispels critics’ concerns that the clinical benefits of treatment will be compromised in OPC programs because patients view OPC as coercive.

        The program could be improved further and the results enhanced by streamlining the procedures available for enforcing the court orders. Until the end of October 1998, there was no mechanism available to enforce compliance with treatment orders. The procedure that was finally put in place is too cumbersome to be effective. The enforcement provisions of the statute (NY Mental Hygiene Law §9.61) must be re-examined to ensure that the process is streamlined while still protecting the individual’s rights.

        The law that created the Bellevue OPC program is scheduled to expire on June 30, 1999. Public hearings will be held on Wednesday, December 16, 1998 at New York University Medical Center from 4:00 p.m. to 8:00 p.m. on the effectiveness of the Bellevue OPC program and whether to extend the program.

        The overall success of the program in reducing the rates of rehospitalization and length of hospital stays warrants extending the pilot program and expanding it throughout the state of New York.  (Posted 2/1999)

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