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.
In my opinion, having this tool available enhanced these patients’ civil rights in that they were able to live in the community rather than being imprisoned, as so many of the severely mentally ill now find themselves.
Other approaches that are voluntary, such as the emotional CPR program Dr. Fisher refers to, are necessary and helpful, but there are rare cases in which voluntary programs are insufficient.