Rights, wrongs, and the dilemma of coerced community treatment.

An outpatient treatment approach directed to patients with histories of psychotically based dangerousness, poor compliance, and recidivism is described. Cases are presented that suggest favorable outcomes of this approach, but the coercive nature of the treatment raises questions about the psychiatrist's violation of patients' rights and transgression of ethical standards. If psychiatrists are to successfully treat the most difficult chronic patients, can we do it without legally sanctioned, benevolent, coercive treatments? One model of such treatment is outpatient commitment. There is concern that without sound outpatient commitment statutes, we may witness the reemergence of asylums.