In response to the letter by Daniel B. Fisher (“Outpatient commitment would harm patients in need,” Jan. 1), I disagree with his assessment that outpatient commitment for psychiatric patients should be considered as harmful. In my training as a psychiatrist, I saw outpatient commitment being used in a helpful, thoughtful way. It was used rarely — only for those patients or clients for whom there was a clearly documented history of violence when off their medication, and a clear positive response to their medication when they were taking it regularly (in these cases, by injection once or twice a month).
The patients and clients were aware that if they slipped off their medicines when taking them by daily oral doses, as a result of carelessness or ambivalence, their mental illness would soon impair their judgment enough that they would refuse to restart their medicines, and they would end up in a downward spiral that was likely to end in aggression. They wanted neither to perpetrate violence on others, nor to end up incarcerated themselves.