Outcomes Associated With Court- Ordered Treatment Over Objection in an Acute Psychiatric Hospital

The postdischarge outcomes of court-ordered treatment of acute psychiatric inpatients have not been adequately investigated. We reviewed the medical records of all patients who refused medication for whom a court order was sought during a recent three-year period, and compared this group to control patients who agreed to treatment and a group of patients who transiently refused medication. The principal outcome measures were successful linkage after discharge, readmission within six months of discharge, and transfer to a state hospital. The study group was less likely to link to an aftercare provider, and more likely to be transferred to a state hospital, had poorer insight on admission, had a longer average stay, and was more likely to utilize mandatory outpatient treatment and long-acting injectable medications after discharge. Patients who require court-ordered medication over objection constitute a group that is high risk for nonadherence after discharge and being refractive to treatment. J Am Acad Psychiatry Law 41:236–44, 2013 Medication refusal among hospitalized patients with severe psychiatric disorders is common,1 with rates of psychotropic medication refusal ranging from ap-proximately 2 to 44 instances per month per 100 admissions.2 Owiti and Bowers2 attribute the vari