Outpatient commitment: a therapeutic jurisprudence analysis.

This article analyzes the legal and therapeutic jurisprudence considerations raised by outpatient commitment. Although older forms of outpatient commitment have both legal and therapeutic advantages, preventive outpatient commitment raises serious legal problems and potential antitherapeutic consequences that may outweigh its claimed therapeutic value. As a result, alternatives are proposed, including wider availability of community treatment and outreach and case management services, assertive community treatment, police and mental health court diversion programs, and creative uses of advanced directive instruments and behavioral contracting. Proposals also are made for how preventive outpatient commitment can be applied more therapeutically, including hearings that accord patients a sense of procedural justice and techniques designed to motivate individuals facing such hearings to agree to accept treatment voluntarily.     

Outpatient civil commitment: a dangerous charade or a component of a comprehensive institution of civil commitment?

This article examines three criticisms frequently directed toward preventive commitment as one form of outpatient commitment. These criticisms contend that preventive commitment (a) abandons the dangerousness criteria for civil commitmnet, (b) promotes unwarranted inpatient commitment of those who do not meet civil commitment criteria, and (c) undermines important individual liberties by diluting the right to refuse treatment. Understanding and evaluating these criticisms requires analysis of the intersection among empirical, conceptual, and justificatory claims. According to the analysis presented here, advocates of preventive commitment can defend a legitimate role for preventive commitment. This analysis applies to preventive commitment as a dispositional alternative within a comprehensive institution of civil commitment involving distinct parens patriae and police power components.     

Outpatient civil commitment in Texas for management and treatment of sexually violent predators: a preliminary report

Texas established in 1999 outpatient civil commitment for sexually violent predators discharged from prison with or without parole. These individuals suffer from a behavioral abnormality, have been convicted of two or more sexually violent crimes and are deemed likely to reoffend. Civilly committed individuals are managed by a team composed of case manager (supervision), treatment provider, public safety officer (global positioning satellite monitoring), and other professionals. Treatment consists of individual and group therapy using a standard workbook. Out of 21 committed individuals, 7 are in the treatment, 1 died, 10 are in custody after breaking conditions of commitment that constitute a felony, and 3 await release from prison. Cost of outpatient civil commitment is less than $20,000/person/year compared with more than $100,000 for inpatient commitment in other states. Texas has found outpatient civil commitment to be an effective and relatively low-cost way to protect the public and treat the offender.     

Sexual predator civil commitment: a comparison of selected and released offenders

This study compared two groups of sex offenders who were considered for civil commitment under Florida's Jimmy Ryce Act: Two hundred twenty-nine sex offenders who were recommended by forensic evaluators to be civilly committed and 221 sex offenders who were recommended for release. It was hypothesized that selected offenders would be more likely to display risk factors for sex offense recidivism than those who did not meet criteria. Data analyses revealed that selected offenders, as a group, scored significantly higher on actuarial risk assessment instruments. There were also significant differences between the groups on other risk factors that have been empirically correlated with sexual recidivism. Selected offenders had higher frequencies of paraphilia diagnoses and antisocial personality. These findings supported the hypotheses and suggested that evaluators are correctly selecting for civil commitment those sex offenders who have a mental abnormality predisposing them to sexual violence and who are at higher risk for reoffense.     

Outpatient commitment: the state of empirical research on its outcomes.

This article briefly describes the historical conditions in the origin and development of outpatient commitment that framed the discourse on its merits and the empirical studies on its outcomes. It divides those empirical studies into two sets on the basis of the questions addressed and critically reviews them. The review pays particular attention to the latest studies that were able to randomize subjects to experimental and control conditions and that were able to offer enhanced services. Finally, this article presents issues not addressed by the empirical studies on outpatient commitment but that need to be addressed in order to understand the choice of using the law to force persons with mental illness to comply with treatment and receive services in the community.     

Moral wrongfulness and insanity: a New Zealand sample

Introduction: This study sought to identify the common characteristics amongst defendants found legally insane, compared to those who were psychiatrically evaluated yet convicted of their crime. Method: A retrospective review of court-ordered psychiatric court reports and legal outcomes was conducted, for all defendants referred for insanity evaluations in the largest city in New Zealand (and its surrounding rural regions) for a 7-year period. Results: The majority (60%; 37) of those referred for evaluation were found legally insane. The opinion regarding moral wrongfulness was the single factor that differentiated successful insanity defendants from those who were found guilty. Conclusions: Despite the centrality of the insanity defence to forensic psychiatry, few studies internationally consider characteristics of those found insane, particularly in comparison with those who are found guilty. Psychiatrically evaluated defendants in this sample were relatively homogenous, perhaps due to the court liaison nurse screening process.     

Civil commitment to outpatient psychotherapy: a case study

Commitment to outpatient psychiatric treatment evolved in the courts to protect patients' right to freedom from compulsory hospitalization. This ruling has been criticized by the psychiatric profession, who prioritize treatment rather than liberty. The following case demonstrates the use of commitment as a therapeutic tool in the psychotherapy of a woman with severe borderline pathology. Although the use of coercion in psychotherapy is controversial, its potential use and its ramifications on transference and countertransference issues are discussed.     

A comparison of sexual coercion experiences reported by men and women in prison

Comparisons were made between self-reports from 382 men and 51 women who had experienced sexual coercion while incarcerated. Victim data were obtained from a sample of 1,788 male inmates and 263 female inmates who responded to an anonymous written survey distributed in 10 midwestern prisons. Men reported that their perpetrators in worst-case incidents were inmates (72%), staff (8%), or inmates and staff collaborating (12%). Women reported that their perpetrators were inmates (47%) and staff (41%). Greater percentages of men (70%) than women (29%) reported that their incident resulted in oral, vaginal, or anal sex. More men (54%) than women (28%) reported an incident that was classified as rape. Men and women were similar in feeling depression; however, more men (37%) than women (11%) reported suicidal thoughts and suicide attempts (19% for men, 4% for women). Implications of results for prevention of sexual coercion in prison are discussed.     

New Zealand: Public Registers Report

In September 2007, the Commonwealth Law Bulletin (Vol. 33, No. 3), published an article on the New Zealand Law Commission’s Issues Paper on Public Registers (IP 3, 2007), including the four options for reform that the Commission was putting forward for consideration by interested persons.

The Law Commission’s Public Registers Report ¹ 1 New Zealand Law Commission’s Public Registers Report, NZLC R 101 2008. (the Report) has now been published, completing stage 2 of the Law Commission’s four stage Privacy Review.

It is available on the Law Commission’s website at http://www.lawcom.govt.nz.     

Work commitment in the legal profession: a study of Baby Boomers and Generation Xers

Growing attention is being paid to the generational differences in the work orientations of professionals, particularly among Baby Boomers and Generation Xers. It is suggested that the role that work plays in one's life is the most significant generational difference, where Generation Xers are viewed as less committed to work, careers and employers than Baby Boomers. Most of this literature however is supported at best by anecdotal evidence rather than empirical data. This paper empirically addresses two questions: (1) are Generation X lawyers less committed to their work than Baby Boomer lawyers?; and (2) do the factors related to work commitment differ for Generation X lawyers and Baby Boomer lawyers? The regression results show there is no significant generational difference in work commitment. The generations do differ in the factors that are related to their work commitment however. Work effort and extrinsic rewards are generally more highly related to Baby Boomers' commitment and intrinsic rewards to Generation Xers' work commitment.