PubMed Health⌕ Search

Biomedical subjects

V A Hiday

Publications and source records attributed to V A Hiday.

At least 19 recordsLinked to original sources
PubMed2000

Involuntary out-patient commitment and reduction of violent behaviour in persons with severe mental illness.

BACKGROUND: Violent behaviour among persons with severe mental illness (SMI) causes public concern and is associated with illness relapse, hospital recidivism and poor outcomes in community-based treatment. AIMS: To test whether involuntary out-patient commitment (OPC) may help to reduce the incidence of violence among persons with SMI. METHOD: One-year randomised trial of the effectiveness of OPC in 262 subjects with psychotic or major mood disorders and a history of hospital recidivism. Involuntarily hospitalised subjects awaiting OPC were randomly assigned to release or court-ordered treatment after discharge. Those with a recent history of serious assault remained under OPC until expiry of the court order (up to 90 days); then OPC orders were renewed at clinical/court discretion. Control subjects had no OPC. Four-monthly follow-up interviews with subject, case manager and collateral informant took place and service records were collected. RESULTS: A significantly lower incidence of violent behaviour occurred in subjects with > or = 6 months' OPC. Lowest risk of violence was associated with extended OPC combined with regular out-patient services, adherence to prescribed medications and no substance misuse. CONCLUSIONS: OPC may significantly reduce risk of violent behaviour in persons with SMI, in part by improving adherence to medications while diminishing substance misuse.

Adolescent↗
PubMed1999

Can involuntary outpatient commitment reduce hospital recidivism?: Findings from a randomized trial with severely mentally ill individuals.

OBJECTIVE: The goal of this study was to evaluate the effectiveness of involuntary outpatient commitment in reducing rehospitalizations among individuals with severe mental illnesses. METHOD: Subjects who were hospitalized involuntarily were randomly assigned to be released (N = 135) or to continue under outpatient commitment (N = 129) after hospital discharge and followed for 1 year. Each subject received case management services plus additional outpatient treatment. Outpatient treatment and hospital use data were collected. RESULTS: In bivariate analyses, the control and outpatient commitment groups did not differ significantly in hospital outcomes. However, subjects who underwent sustained periods of outpatient commitment beyond that of the initial court order had approximately 57% fewer readmissions and 20 fewer hospital days than control subjects. Sustained outpatient commitment was shown to be particularly effective for individuals with nonaffective psychotic disorders, reducing hospital readmissions approximately 72% and requiring 28 fewer hospital days. In repeated measures multivariable analyses, the outpatient commitment group had significantly better hospital outcomes, even without considering the total length of court-ordered outpatient commitments. However, in subsequent repeated measures analyses examining the role of outpatient treatment among psychotically disordered individuals, it was also found that sustained outpatient commitment reduced hospital readmissions only when combined with a higher intensity of outpatient treatment. CONCLUSIONS: Outpatient commitment can work to reduce hospital readmissions and total hospital days when court orders are sustained and combined with intensive treatment, particularly for individuals with psychotic disorders. This use of outpatient commitment is not a substitute for intensive treatment; it requires a substantial commitment of treatment resources to be effective.

Adult↗
PubMed1999

Criminal victimization of persons with severe mental illness.

OBJECTIVE: The types and amounts of crime experienced by persons with severe mental illness were examined to better understand criminal victimization in this population. METHODS: Subjects were 331 involuntarily admitted psychiatric inpatients who were ordered by the court to outpatient commitment after discharge. Extensive interviews provided information on subjects' experience with crime in the previous four months and their perceived vulnerability to victimization, as well as on their living conditions and substance use. Medical records provided clinical data. RESULTS: The rate of nonviolent criminal victimization (22.4 percent) was similar to that in the general population (21.1 percent). The rate of violent criminal victimization was two and a half times greater than in the general population--8.2 percent versus 3.1 percent. Being an urban resident, using alcohol or drugs, having a secondary diagnosis of a personality disorder, and experiencing transient living conditions before hospitalization were significantly associated with being the victim of a crime. In the multivariate analysis, substance use and transient living conditions were strong predictors of criminal victimization; no demographic or clinical variable was a significant predictor. (Given the relatively high crime rates, subjects' perceived vulnerability to victimization was unexpectedly low; only 16.3 percent expressed concerns about personal safety. Those with a higher level of education expressed greater feelings of vulnerability. CONCLUSIONS: The study found a substantial rate of violent criminal victimization among persons with severe and persistent mental illness. Results suggest that substance use and homelessness make criminal victimization more likely.

Adult↗
PubMed1999

Consumer perceptions of involuntary outpatient commitment.

This study examined beliefs about the provisions of outpatient commitment and their effects among 306 people with severe and persistent mental illness who were awaiting a period of outpatient commitment. More than 80 percent of the respondents perceived that the court order for outpatient commitment required them to keep their appointments at the mental health center and to take medication as prescribed. More than three-quarters believed that the outpatient commitment order made it more likely that people would keep their mental health appointments, take their medication, and stay out of the hospital.

Adult↗
PubMed1998

Male-female differences in the setting and construction of violence among people with severe mental illness.

Data from a sample of severely and persistently mentally ill involuntary patients indicated that differences in violence between males and females in the 4 months prior to hospital admission depended on the measure. In the bivariate analysis, males had a greater prevalence of violence on the two indicators which separated more serious violence from lesser and no violence; but there was no gender difference on the more inclusive measure which incorporated threats and fights not involving weapons or injuries. In multivariate analysis when other relevant predictors were controlled, gender was significant in predicting only the most inclusive indicator of violence and only in interaction with substance abuse problems.

Adult↗
PubMed1998

Taking the wrong drugs: the role of substance abuse and medication noncompliance in violence among severely mentally ill individuals.

Increasing numbers of severely mentally ill individuals are being treated in nonhospital, community-based settings and public concern about potential violence by these individuals has increased, often as a result of tragic, albeit uncommon events. The present study examines potential predictors of serious violence among persons with severe mental illness (SMI), with a specific focus on the joint effect of substance abuse and medication noncompliance. Subjects in the study are involuntarily admitted inpatients with SMI awaiting a period of court-ordered outpatient treatment, termed "involuntary outpatient commitment". During enrollment in a longitudinal outcome study of the effectiveness of OPC, 331 subjects and, whenever feasible, family members or other informants were interviewed. In addition, complementary data were gathered by review of involuntary commitment records and hospital records. Data collection included sociodemographic characteristics, illness history, clinical status, medication adherence, substance abuse and violent behavior during the 4 months preceding hospitalization. Descriptive and multivariable logistic regression procedures were used to examine the association between serious violent acts and a number of personal, social, and clinical characteristics. The combination of medication noncompliance and substance abuse was a significant predictor of serious violent acts in the community. Individuals who had problems with both alcohol and illicit drug abuse appear to be at greatest risk for violence. These results suggest that reducing violence risk among persons with SMI requires an aggressive approach to improving medication adherence in the context of integrated mental health and substance abuse treatment.

Adolescent↗
PubMed1998

Violence and severe mental illness: the effects of substance abuse and nonadherence to medication.

OBJECTIVE: Violent behavior among individuals with severe mental illness has become an important focus in community-based care. This study examines the joint effect of substance abuse and medication noncompliance on the greater risk of serious violence among persons with severe mental illness. METHOD: Involuntarily admitted inpatients with severe mental illness who were awaiting a period of outpatient commitment were enrolled in a longitudinal outcome study. At baseline, 331 subjects underwent an extensive face-to-face interview. Complementary data were gathered by a review of hospital records and a telephone interview with a family member or other informant. These data included subjects' sociodemographic characteristics, illness history, clinical status, medication adherence, substance abuse, insight into illness, and violent behavior during the 4 months that preceded hospitalization. Associations between serious violent acts and a range of individual characteristics and problems were analyzed by using multivariable logistic regression. RESULTS: The combination of medication noncompliance and alcohol or substance abuse problems was significantly associated with serious violent acts in the community, after sociodemographic and clinical characteristics were controlled. CONCLUSIONS: Alcohol or other drug abuse problems combined with poor adherence to medication may signal a higher risk of violent behavior among persons with severe mental illness. Reduction of such risk may require carefully targeted community interventions, including integrated mental health and substance abuse treatment.

Adolescent↗
PubMed1997

The ethical challenges of a randomized controlled trial of involuntary outpatient commitment.

Involuntary outpatient commitment (OPC) is a civil justice procedure intended to enhance compliance with community mental health treatment, to improve functioning, and to reduce recurrent dangerousness and hospital recidivism. The research literature on OPC indicates that it appears to improve outcomes in rates of rehospitalization and length of stay. However, all studies to date have serious methodological limitations because of selection bias; lack of specification of target populations; unclear operationalization of OPC; unmeasured variability in type, frequency, and intensity of treatment; as well as other confounding factors. To address limitations in these studies, the authors designed a randomized controlled trial (RCT) of OPC, combined with community-based case management, which is now under way in North Carolina. This article describes ethical dilemmas in designing and implementing an RCT of a legally coercive intervention in community-based settings. These ethical dilemmas challenge the experimental validity of an RCT but can be successfully addressed with careful planning and negotiation.

Ambulatory Care↗
PubMed1997

Interpreting the effectiveness of involuntary outpatient commitment: a conceptual model.

Many experimental trials of community mental health interventions fail to develop testable conceptual models of the specific mechanisms and pathways by which relevant outcomes may occur, thus falling short of usefully interpreting what happens inside the experimental "black box." This paper describes a conceptual model of involuntary outpatient commitment (OPC) for persons with severe and persistent mental disorders. The model represents an attempt to "unpack" the effects of OPC by incorporating several interacting variables at various stages. According to this model, court-mandated outpatient treatment may improve long-term outcomes both directly and indirectly in several ways: by stimulating case management efforts, mobilizing supportive resources, improving individual compliance with treatment in the community, reducing clients' psychiatric symptoms and dangerous behavior, improving clients' social functioning, and finally by reducing the chance of illness relapse and rehospitalization. A randomized clinical trial of OPC is underway in North Carolina that will test the direct and indirect effects suggested by this model, using longitudinal data from the multiple perspectives of mental health clients, family members, and case managers.

Ambulatory Care↗
PubMed1995

New directions in research on involuntary outpatient commitment.

OBJECTIVE: Involuntary outpatient commitment has been used as a method of improving tenure in community programs for individuals with severe and persistent mental illness. This paper reviews literature on research about involuntary outpatient commitment and suggests questions and methods for future research. METHODS: Literature describing research studies of involuntary outpatient commitment, located by searching MEDLINE and following up references cited in relevant articles, was reviewed with attention to patient characteristics and diagnostic, treatment, and outcomes measures. RESULTS: Involuntary outpatient commitment appears to provide limited but improved outcomes in rates of rehospitalization and lengths of hospital stay. Variability in community treatment makes interpretation of other types of outcome difficult. Few studies specifically identify results among patients with severe and persistent mental illness. CONCLUSIONS: No studies have examined the extent to which outpatient commitment affects compliance and treatment when essential community services such as case management are consistently and aggressively provided, nor have studies controlled for potentially confounding factors such as treatment and nontreatment effects, including informal coercion. A randomized trial of involuntary outpatient commitment should be useful in evaluating the effectiveness of this type of intervention.

Ambulatory Care↗
PubMed1995

The social context of mental illness and violence.

For years a debate existed in the literature concerning whether or not mentally ill persons were more dangerous than others. Empirical work was hampered by conceptual and methodological shortcomings, and was therefore unable to settle the debate. Recently, methodologically sophisticated studies have produced evidence which indicates a modest association between active major mental disorders and violence. While some interpret this association to mean that mental illness or particular symptoms directly cause unwarranted physical aggression, this paper examines the case for the social context establishing socializing and environmental conditions which are causal in both violence and the development of mental disorder. It reviews the literature, indicating lacunae in our knowledge base, and posits a causal model which links social stratification with both mental illness and violence through the structured types of strains, events, situations and persons an individual experiences as an integral part of life.

Humans↗
PubMed1992

Civil commitment and arrests. An investigation of the criminalization thesis.

This study examined one part of the criminalization thesis, which holds that the dangerousness standard of reform civil commitment law has led to the frequent arrest of mentally ill persons. It followed a large statewide sample of civil commitment candidates for 6 months through arrest records to observe their number and type of arrests. It found that: ex-candidates were seldom arrested; over half of arrests were accounted for by a few with multiple arrests; the nonviolent and those released were no more likely to be arrested than the violent and those committed; and charges were more often for the less serious offenses, but not predominantly for nuisance offenses [corrected].

Adult↗
PubMed1991

Outpatient commitment for "revolving door" patients: compliance and treatment.

This paper describes the use and effectiveness of outpatient commitment in inducing compliance with treatment among chronically mentally ill "revolving door" patients, those who recurrently become dangerous and revolve though civil commitment courts as well as state mental hospitals. Patients characteristics, treatment modalities, and mental health center actions to ensure compliance are described. Comparison of those patients ordered to outpatient commitment with those having other court dispositions (involuntary hospitalization and release) indicates that outpatient commitment induces compliance and leads to treatment maintenance even after the court order terminates.

Ambulatory Care↗
PubMed1991

Arrest and incarceration of civil commitment candidates.

To gauge whether more stringent civil commitment criteria have led to the criminalization of mentally ill persons, forcing them into jails and prisons instead of treating them, a statewide sample of 1,226 civil commitment candidates in North Carolina was tracked for six months after their commitment hearings. Only 72 sample members were arrested during the period, mostly for burglary or larceny (22 arrests), simple or aggravated assault (17 arrests), and minor offenses (40 arrests), including drunkenness, trespassing, and traffic violations. Fourteen sample members were jailed, and two were sent to prison. The mentally ill who were not involuntarily hospitalized or who were hospitalized for only short periods were seldom arrested; when they were arrested, the charges were generally for nondangerous offenses.

Adult↗