Involuntary outpatient treatment in England and Wales

Purpose of Review The introduction of compulsory community treatment has recently been proposed in England and Wales, despite the lack of evidence to suggest that it will be effective in either reducing risk or improving care. The proposed legislation includes provisions for all the principal types of involuntary outpatient treatment (IOT): diversion from hospital to compulsory treatment, conditional discharge, and preventive treatment. Controversially, the proposals also extend to those with personality disorders for whom effective treatments may be unavailable. Recent research on IOT, and its relevance to the proposals, is reviewed. Recent findings In the last year there have been further reports from the two RCTs of IOT, a new cohort study, and further debates about ethics and effectiveness. IOT continues to spread despite the failure of research to show clear benefits, and the new proposals for England and Wales raise issues not yet considered by systematic research. Summary Randomized controlled trials of the proposed legislation are unlikely to be carried out. However, the question of the effectiveness of IOT remains important for research. Other possibilities for research include further database studies, and also work which develops concepts and measures, and models the interacting components of this most complex of interventions.