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The Boston Globe



In rare cases, outpatient commitment for mentally ill can be crucial tool

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.

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