Conclusions that can be drawn from pilot Assisted Outpatient Treatment program at Bellevue Hospital.
In spite of the limitations of the Policy Research Associates report on Assisted Outpatient Treatment Pilot Program at Bellevue, we point out the following:
The statement that enhanced services reduces rehospitalization and cuts down on the need for Assisted Treatment is true. 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.
The positive effect of Assisted Outpatient Treatment would have been more profound if the violent had not been excluded from the program.
The positive effect of Assisted Outpatient Treatment would have been more profound if MICA patients were evenly distributed rather than concentrated in the group that recieved treatment orders.
The positive effect of Assisted Outpatient Treatment would have been more profound if the study was a real world study, rather than one where individuals received enhanced services.
The positive effect of Assisted Outpatient Treatment would have been more profound if individuals had not been required to agree to longer inpatient stays while housing was found.
The positive effect of Assisted Outpatient Treatment would have been more profound if those who lacked competency and/or capacity had not been excluded.
The positive effect of Assisted Outpatient Treatment would have been more profound if fair, humane and workable procedures for medicating individuals over objection in the community been in place and utilized.
The authors of the study minimized the following findings:
Outpatient Assisted Treatment cut down on inpatient utilization: Controls were hospitalized for 101 days in the 11 months following discharge while those who were under court orders only had 43 days of hospitalization.
Outpatient Assisted Treatment helped substance abusers get re-hospitalized faster, before deteriorating to ‘dangerousness’: Of those with substance abuse problems, 66% of the court ordered subjects were rehospitalized versus only 44% of the controls.
Outpatient Assisted Treatment dramatically cut down on the need for long-term hospitalization: “Controls who were rehospitalized were 2 1/2 times more likley than those in the court ordered group to be transferred to the state hospital”. This leads to radically longer hospital usage and increased costs. So OPC apparently cut down on state hospital usage, an important economic fact as we take this forward.
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.
Individuals who received court orders were more likely to take their medications. When service providers were asked to assess the medication compliance of their patients, 57% of individuals that received medication orders from the court at the time of their hearing were viewed as 75-100% compliant, but only 39% of those with commitment orders that did not include medication compliance conditions were so highly rated. One would expect judges to enter treatment orders for those that they believe likely to be non-compliant, but those in the study who were subject to court orders were actually more compliant. This was, again, not seen as statistically significant in the report. (Posted 2/1999)
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