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Outpatient commitment: treatment in the least restrictive environment?

Despite the growing emphasis on treatment in the least restrictive environment, states rarely use commitment to outpatient treatment as an alternative to involuntary hospitalization. The authors studied the effects of changes in North Carolina commitment laws that were made in 1979 and designed to facilitate the appropriate use of outpatient commitment. The changes resulted in some increase in the appropriate use of outpatient commitment; nevertheless, clinicians who work at hospitals and community treatment facilities continue to doubt its efficacy. The authors discuss possible reasons for the clinicians' reluctance to use outpatient commitment and attitudinal shifts needed on the part of the general public, professionals, and the judiciary if outpatient commitment is to become a viable alternative.