Runnning head: ARTICLE REVIEW Pizarro 1

Article Review of Mandated Community Treatment: Beyond Outpatient Commitment

Dominic Pizarro
California State University, Long Beach















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Article Review of Mandated Community Treatment: Beyond Outpatient Commitment
Monahan, J., Bonnie, R. J., Appelbaum, P. S., Hyde, P. S., Steadman, H. J., & Swartz, M. S.
(2001). Mandated community treatment: Beyond outpatient commitment.
Psychiatric Services, 52(9), 1198-1205. doi:10.1176/appi.ps.52.9.1198
In Mandated Community Treatment, John Monahan, Richard J. Bonnie, Paul S.
Appelbaum, Pamela S. Hyde, Henry J. Steadman, and Marvin S. Swartz describe the multiple
forms of mandated community treatment, the use of multiple leverages in order to ensure
treatment adherence, and the ethical and legal ramifications of the previously mentioned
leverages. Monahan, Bonnie, Appelbaum, Hyde, Steadman, and Swartz are writing for an
audience of mental health professionals who are greatly opposed to mandated outpatient
treatment. Targeting such a professional audience, Monahan, Bonnie, Appelbaum, Hyde,
Steadman, and Swartz fail to address a secondary audience, individuals with mental illness and
their families. Individuals diagnosed with mental illness and their family members personally
experience the effects of mandated outpatient treatment and therefore must not be overlooked
when attempting to inform audiences of the particular aspects of mandated outpatient treatment.
Even though this major flaw is apparent in their article, Monahan, Bonnie, Appelbaum, Hyde,
Steadman, and Swartz do not formulate their argument with professional jargon, allowing non-
professionals to read their article and obtain the necessary information. Monahan, Bonnie,
Appelbaum, Hyde, Steadman, and Swartz also do not negatively attack the stance of those
mental health professionals who are opposed to mandated outpatient treatment, rather Monahan,
Bonnie, Appelbaum, Hyde, Steadman, and Swartz present these individuals with factual
evidence that leads to a logical conclusion.
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Monahan, Bonnie, Appelbaum, Hyde, Steadman, and Swartz clearly explain their
interpretive approach of mandated outpatient treatment by stating:
First, we review what is known about the variety of influences that are brought to bear on
a patients choice of whether to accept mental health services in the community. Second,
we discuss what needs to be known about these various forms of mandated treatment so
that their potential role in mental health law and policy can be properly assessed.
(pg. 1198)
Monahan, Bonnie, Appelbaum, Hyde, Steadman, and Swartz analyze the influences of money,
housing, avoidance of jail, and avoidance of hospitalization upon individuals with mental
illnesses and continue to give a detailed description of the individuals leverage aspects. The
focus on these major leverages overshadows another important factor in a mental ill individuals
decision making process, familial influences. Although the influence of family is briefly touched
upon in this article, Monahan, Bonnie, Appelbaum, Hyde, Steadman, and Swartz fall short on
recognizing that a mentally ill individual may base their decisions upon the consent, agreement,
or approval of one or multiple family members. Even so, Monahan, Bonnie, Appelbaum, Hyde,
Steadman, and Swartzs systematic approach to mandate outpatient treatment is easy to follow
and can be applied to interpret other possible texts concerning mandated outpatient treatment;
Monahan (2005) has contributed additional research with his colleagues on this topic including
his article Use of Leverage to Improve Adherence to Psychiatric Treatment in the Community.
Monahan, Bonnie, Appelbaum, Hyde, Steadman, and Swartz construct their argument in
an organized manner by individually listing the leverage factors and then giving examples or
detailed descriptions of these leverages in action. Beginning by stating that only in relation to
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these other forms of mandated treatment in the open community, rather than to the body of law
and policy developed for confinement in an inpatient facility, can outpatient commitment be
adequately understood (p. 1199), Monahan, Bonnie, Appelbaum, Hyde, Steadman, and Swartz
argue that not only governmental officials but also civilian landlords exercise their power beyond
a court mandate in order to increase treatment adherence. Monahan, Bonnie, Appelbaum, Hyde,
Steadman, and Swartz draw upon the work of MI Rosen and R Rosenheck (1999) in their article
Substance use and assignment of representative payees to draw attention to the the mental
health systems belief that mentally ill individuals receiving treatment are not able to handle their
own finances and therefore must have a representative payee. (Rosen and Rosenheck 1999)
Monahan, Bonnie, Appelbaum, Hyde, Steadman, and Swartz address the efficiency of
mandate outpatient treatment, but fail to recognize the barriers created by the opposition; Joel M.
Silberberg, Terri L. Vital, and S. Jan Brakel addressed these barriers in their article Breaking
Down Barriers to Mandated Outpatient Treatment for Mentally Ill Offenders, where Silberberg,
Vital, and Brakel argued that the barriers to mandated treatment exist within the components of
the system, as well as among them (Silberberg, Vital, and Brakel 2001). If Monahan, Bonnie,
Appelbaum, Hyde, Steadman, and Swartz had conducted such a thorough search of the mandated
outpatient treatment program as they attest to, they should have noticed the shortcomings that
exist within the program and which prevent any further progress from being made.
Monahan, Bonnie, Appelbaum, Hyde, Steadman, and Swartzs article presents their study
findings and argument in a clear and concise manner which is understandable by individuals
beyond the intended professional audience. Despite the minor shortcomings, Monahan, Bonnie,
Appelbaum, Hyde, Steadman, and Swartz develop a strong argument by referencing the previous
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work of other mental health professionals concerning this text and open a new perspective on the
methods used to increase treatment adherence. In order to overcome their shortcomings,
Monahan, Bonnie, Appelbaum, Hyde, Steadman, and Swartz need to narrow their focus, conduct
further studies, and be sure to address the use of family as leverage when concerning mental ill
individuals and mandated outpatient treatment.

















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Refrences
Monahan J, Redlich AD, Swanson J, et al: Use of leverage to improve adherence to psychiatric
treatment in the community. Psychiatr Serv 56:37 44, 2005
Rosen MI, Rosenheck R: Substance use and assignment of representative payees. Psychiatric
Services 50:9598, 1999
Silberberg, J. M., Vital, T. L., & Brakel, S. (2001). Breaking down barriers to mandated
outpatient treatment for mentally ill offenders. Psychiatric Annals, 31(7), 433-440.
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