Long-term follow-up of rural involuntary clients

A cohort of 72 persons who had entered a rural Oregon county's involuntary treatment system in 1979 through 1982 was followed for six years. While schizophrenia was the most frequent diagnosis, several other conditions were represented including adjustment disorders, organic mental disorders, and substance abuse. The majority (55%) of persons with organic mental disorders died as did 12% of the individuals with schizophrenia. The overall mortality rate was three times the expected figure (p=.002). During the follow-up period, only 39% of the initial cohort received treatment from a community mental health program whereas 28% were newly admitted (involuntarily) to a state mental hospital. Hospital recividism was most likely among individuals who had had prior involuntary treatment. At least in rural areas, the civil commitment system seems to serve both "infrequent" and "persistent" users. Infrequent users mainly have diagnoses of adjustment disorders and/or substance abuse. Persistent users chiefly have diagnoses of organic mental disorders, mood disorders, or schizophrenia. Modifying the involuntary treatment system to take account of this heterogeneous population's diverse needs is discussed.