The outpatient commitment of psychiatric patients has become increasingly widespread and controversial. It is also commonly referred to as assisted outpatient treatment (AOT), such as Kendra's law in New York state. I have not seen reference to its origins. One possibility is that it was first used at St. Elizabeths Hospital in Washington, D.C., in April 1972. At that time, the Area D Community Mental Health Center was on the grounds of the hospital under the directorship of Dr. Roger Peele. One day over lunch, Dr. Peele and Dr. Armando Saenz, a ward psychiatrist, were trying to decide what to do with a patient scheduled for discharge but who still needed supervision with her medication. Since she could legally be committed to inpatient status, Drs. Peele and Saenz wondered why they could not commit her to outpatient care instead. They raised this option with the Mental Health Commission, and the woman's lawyer, a respected public defender named Harry Fulton, agreed to it.

Outpatient commitment then became increasingly popular at St. Elizabeths. The CME Newsletter published at the hospital in December 1984 summarized the experience with 293 patients committed to outpatient care between 1972 and 1984 and reported very favorable results: "The attorney chairman of the Mental Health Commission, who had served for the past 15 years, viewed outpatient commitment as effective and as a less restrictive alternative. He found it worked best for patients who needed to stay on medication and had no insight. Families of patients have reported to him that they found outpatient commitment extremely helpful" (D. Band J, et al: Outpatient Commitment: A 13-Year Experience. CME Newsletter 5:1-5, 1984). Two years later, much of these data were reported in "Inpatient Stays Before and After Outpatient Commitment" by Guido Zanni and Leslie de Veau and published in the September 1986 Hospital and Community Psychiatry,

Does anyone know of a use of outpatient commitment earlier than April 1972? If not, then Drs. Peele and Saenz and attorney Fulton should be recognized as the legitimate parents of this offspring.

E. FULLER TORREY, M.D.
Bethesda, Md.