Evaluating the use of Supervised Discharge and Guardianship in cases of severe mental illness: a follow-up study

Abstract

Objective: The purpose of the study was to evaluate the use of supervision in the community under two provisions of the Mental Health Act 1983, England. Method: A cohort sample of 205 mentally ill patients subject to Supervised Discharge and 121 subject to Guardianship was identified in England. Data were collected at two time points. Outcomes examined were compliance with requirements, clinician ratings of effectiveness of interventions, clinical ratings, ''risk events'' and instances of hospitalization in the study period. Results: High levels of compliance with requirements were achieved, although compliance was sometimes only ''reluctant'' or ''partial''. Interventions involving psychiatric treatment and risk management were most common, and also best maintained between time points. Broader health and social interventions were less common, and declined more in effectiveness between time points. Clinical ratings improved between time points. Conclusions: The measures appear to have been used principally to manage medication and risks, and a good level of compliance was achieved. Interventions to give psychiatric treatment and manage risk were associated with reduced hospitalization amongst Supervised Discharge cases whilst wider social and health interventions were associated with reduced hospitalization in Guardianship cases. Declaration of interest: None.

Coercion and the Mentally Ill: Ethical Perspectives

“…In fact, there is support for the notion that participation in treatment decisions by mentally ill patients results in greater satisfaction and clinical outcomes and that conservatorship negatively affects quality of life (Wilber et al, 2001). However, compulsory outpatient commitment has also demonstrated effectiveness in treatment-plan adherence and reduction in rehospitalization (Hatfield, Bindman, & Pinfold, 2004).…”