Consumer Perspectives on a Newly Implemented Involuntary Outpatient Commitment Program

Background and Purpose:

Limited research exists on consumer perspectives of intensive outpatient commitment in community settings, with much of the literature focused on involuntary hospitalization and inpatient experiences (Canvin, 2016). Research has noted the importance of consumers’ experience and perceptions of coercion for a variety of outcomes; for example, studies conducted in the United Kingdom and Europe show that consumers express ambivalent and contradictory attitudes about involuntary outpatient commitment, but their experiences depend partly upon the quality of the therapeutic relationship. Because therapeutic relationship is deemed necessary for treatment compliance in mental health treatment, it follows that perceptions of provider behavior may an important determinant of consumer experiences of IOC. This paper addresses this gap in the literature by exploring consumer perspectives about a newly implemented IOC program in the United States.

Methods:

Qualitative research methods have been recommended for assessing consumer perspectives of IOC. As part of a larger multi-method evaluation study on a newly-implemented IOC program, in-depth interviews were conducted in-person with recipient stakeholders (n=31) at 6 IOC sites. Purposeful sampling was used to include compliant and non-compliant consumers whose IOC order had recently concluded, those in IOC for 60 days or less, and those in IOC for more than 90 days. Consumers were recruited via site managers and case managers and compensated for their participation. Interviews focused on consumer perceptions and experiences of IOC. Interviews were audio recorded, transcribed, and analyzed using ATLAS.ti. This paper presents overarching themes.

Findings:

Initial responses to IOC were negative for most consumers, but evolved positively as they engaged with the staff. Positive responses to IOC were mainly related to four benefits identified by consumers: resource availability, emotional support, improved mental health, and learned skills. IOC staff fostered engagement by linking consumers with services or resources, providing individualized case management, and organizing recreational activities. Generally, staff members were perceived to be genuine, reliable sources of support, and most consumers interpreted treatment monitoring as supportive and encouraging, rather than coercive or intrusive. For some consumers however, negative aspects of the program, namely the court mandate, overshadowed any benefits to participation. Most consumers felt restricted in their ability to choose enrolling in IOC, yet almost all consumers reported that they would voluntarily re-enroll in the program.

Conclusions and Implications:

Overall, consumers found the IOC program beneficial, and positive engagement with the program was tied to the commitment and efforts of the IOC staff. While the court mandate appears to be the primary program component consumers would like to change or eliminate, without the presence of this imperative, many individuals would opt out of the program before its benefits could be realized. Social workers and other professionals involved in the provision of IOC can help to reduce negative treatment experiences by offering supportive and encouraging relationships to involuntary consumers.