Annually, 40% of seriously mentally ill patients who are discharged from psychiatric facilities are rehospitalized within one year (Klinkenberg & Calysn). Furthermore, the participation rate of these individuals in treatment decreases from 50% the first year, to 15% the second year. The need to improve adherence rates has led clinicians and policy makers to use legal mechanisms to force individuals to adhere to treatment.

One judicial intervention is the use of Court Ordered Treatment (COT). Within this process, the court attempts to act therapeutically on behalf of mentally ill persons to ensure safety to the public. Therapeutic Jurisprudence (TJ) is a conceptual approach to mental health law that focuses on how the law acts as a therapeutic agent (Madden & Wayne, 2003). The TJ perspective attempts to evaluate the therapeutic consequences for individuals, however, it also examines the way mental health laws can have anti-therapeutic consequences on the individual and the community (Wexler, 1997). While 39 jurisdictions utilize a variation of court ordered treatment, the effectiveness of COT and the delivery of outpatient services are lacking convincing evidence (Steadman, Gounis, Dennis, Hopper, Roche, Swartz & Robbins, 2001).

The purpose of this study was to identify variables within the court ordered treatment process that can discriminate between adherence and non-adherence rates. This study reviewed demographic characteristics, the type of court order and the patient's clinical diagnosis.

The study's sample (n = 305)included all adults over the age of 18 who were placed on court ordered treatment between May 1st, 2002 through July 31st, 2002. The type(s) of court orders included in the study were persistently and acutely disabled, gravely disabled, danger to self or danger to others. The demographic, COT type and clinical and functional information for each subject was extrapolated from the Regional Behavioral Health Authority (RBHA) database. Each person who entered court ordered treatment within the three month period was tracked for the subsequent six months to monitor treatment non-adherence. Non-adherence was tracked by the patient's clinics. The clinics recorded this information on a report and the report was cross referenced with the sample participants to determine adherence or non-adherence to treatment. The states level of functioning tool (ALFA) has nine domains and was used by the RBHA to determine functional ability. This study used one- way analysis of variance and cross tabulations to identify initial bivariate relationships. Multivariate discriminate analysis was then used to discriminate between adherence and non-adherence to treatment.

The results showed that the self-care scale, the substance use, ethnic status of being African American, CGI severity scale and the number of times a person was on COT helped discriminate between adherents and non-adherents to court ordered treatment. The implications for policy and practice of these results are discussed with specific attention given to understanding the contributions of African American status to the results.

Key Words: Court Ordered Treatment, Predictor factors, Treatment Adherence, Therapeutic Jurisprudence, African American