Study summary prepared by the Treatment Advocacy Center, Arlington, Va.

An important new study has demonstrated that individuals with severe psychiatric illnesses who were not on outpatient commitment "were almost twice as likely to be victimized as were outpatient commitment subjects," according to the authors of the study. 

The study was carried out by Dr. Virginia Hiday and her colleagues at North Carolina State University and Duke University and is published in the August issue of the American Journal of Psychiatry. 

Dr. Hiday and colleagues obtained detailed information regarding victimization on 184 individuals with schizophrenia, schizoaffective disorder, and affective disorders, who were followed for one year. Eighty-five of the individuals were on outpatient commitment for part or all of the year and 99 were not. Victimization was classified as either a violent crime (e.g., assault, rape, or mugging) or a nonviolent crime (e.g., burglary, theft of money, being cheated) against the psychiatrically ill person. 

Among the 85 individuals on outpatient commitment, 24 percent were victimized, while among the 99 not on outpatient commitment, 42 percent were victimized. The authors noted: "Furthermore, risk of victimization decreased with increased duration of outpatient commitment." 

Individuals in the outpatient-commitment group were victimized significantly less often despite the fact that individuals in both groups received standard outpatient care and case management services. The authors suggest that "outpatient commitment reduces criminal victimization through improving treatment adherence, decreasing substance abuse, and diminishing violent incidents" that may evoke retaliation. 

They believe the reduction of victimization works as follows: 

Medication adherence can be expected to reduce symptoms of severe mental illness and thus reduce victimization. Psychotic symptoms and bizarre behavior can lead to tense and conflictual situations, which, in turn, may result in a patient's victimization - either because others become violent toward the patient or because the patient lashes out physically and others react with stronger violence. By facilitating adherence and ensuring more consistent follow-up, outpatient commitment may lead to reduced symptoms, better functioning in social relationships, and improved judgment. In turn, these changes should lessen a person's vulnerability to abuse by others and lower the probability of becoming involved in dangerous situations where victimization is more likely.

The complete citation for the article is as follows: Hiday VA, Swartz MS, Swanson JW, Borum R, Wagner HR. Impact of outpatient commitment on victimization of people with severe mental illness. Am J Psychiatry 159: 1403-1411, 2002.