1. Behavioral Health Medications and Court-Ordered Treatment Patricia R. Recupero, JD, MD

2. Involuntary Outpatient Commitment Often instituted in response to tragedies Person has serious mental illness Person has a history of not taking medications outside of hospital settings Person has benefitted from medications in the past Without medication, person is at risk of becoming incapacitated or dangerous Person can be taken to mental health clinic for evaluation, but medication cannot be forced

3. Little Difference in Outcomes Coerced treatment for SUD’s may improve rates of retention in treatment, but ultimate outcomes are similar for individuals in coerced treatment and individuals in non-coerced treatment (IOM 2005). There is little difference in actual medication compliance between patients who perceived that medication was forced (“high perceived coercion”) and those who did not feel that they were forced to take medication (TAC 2011; Rain et al. 2003). Cochrane of IOC review showed no significant differences in outcomes, except for rates of victimization

4. Recommendations Consider “root cause analysis” of tragic instances that precipitate IOC legislation Explore utility of earlier intervention and collaborative care planning prior to IOC Should IOC still be considered necessary, allow active role for person in developing care plan (“when North Carolina revised its IOC statute so as to encourage shared decision making, clinical outcomes improved and re- hospitalization rates decreased”)