E D I T O R I A L Alternatives to Outpatient Commitment Michael Rowe, PhD The killing of 26 students and teachers in Newtown, Connecticut last year was committed by a young man, Adam Lanza, who took his own life before po- lice could apprehend him. Investigative news reports and articles have stated that Lanza had received a diagnosis of Asperger’s syndrome with sensory inte- gration disorder. 1 Even before significant investiga- tion into Lanza’s past was conducted, however, the tragedy at Newtown rekindled the debate on legal commitment to outpatient treatment (outpatient commitment) for persons with disabling psychiatric disorders who refuse voluntary treatment. In this ed- itorial, I review both pro and con arguments regard- ing outpatient commitment and the research con- ducted on it and discuss alternative approaches to addressing the objectives of assuring public safety and providing care for persons at risk of violence to self or others who are not engaged in mental health treatment. Outpatient Commitment as Public Policy and Practice The concept and practice of outpatient commit- ment has been a divisive subject in mental health care in the United States for at least two decades. Cur- rently, 44 of 50 states have laws that provide for some form of outpatient commitment. 2,3 Mental health professionals and others have argued that the prac- tice, including commitment to taking prescribed psychiatric medications, can: Be an effective means of providing care to per- sons with mental illness who refuse mental health treatment, 4 including those who lack insight into the fact that they have a mental illness. 5 Spur efforts to identify persons at risk of violence against self or others and, by providing treatment to them, reduce acts of violence committed by members of this group. 6 Reduce the risk of incarceration of mandated persons. 7 Encourage persons who have previously refused treatment to enter treatment willingly. 7 For ex- ample, a colleague worked with homeless persons in New York City when they were notified of their eligibility to receive mandated outpatient commitment after Kendra’s Law went into ef- fect. He stated that a female client, after receiving notification, began to take her prescribed medi- cations immediately, and her thinking and func- tioning improved (personal communication from Charles Barber, February 7, 2013). (Ken- dra’s Law, ironically, was passed in New York State after a man with mental illness, who had repeatedly sought treatment but was turned away, pushed a woman in front of an oncoming subway train in New York City. 4 ) Encourage clinicians to provide coordinated and attentive care to mandated clients. 6 Provide a less restrictive alternative to inpatient commitment for those who refuse outpatient treatment, 8 and help prevent episodes of deteri- Dr. Rowe is Associate Professor, Program for Recovery and Commu- nity Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT. Address correspondence to: Michael Rowe, PhD, Associ- ate Professor, Yale School of Medicine, Department of Psychiatry, Program for Recovery and Community Health, 319 Peck Street, Building 1, New Haven, CT 06513. E-mail: michael.rowe@yale.edu. Disclosures of financial or other potential conflicts of interest: None. 332 The Journal of the American Academy of Psychiatry and the Law