What is assisted outpatient treatment?
An estimated 3.6 million Americans suffer from untreated severe bipolar disorder or schizophrenia (National Institutes of Mental Health, 2010). Assisted outpatient treatment (AOT) is court-ordered treatment for those individuals in this population who meet strict legal criteria. Most commonly, they are too ill to recognize their own need for medical care.
Assisted outpatient treatment is known by different terms in different states, e.g., "involuntary outpatient treatment" or "mandatory outpatient treatment." The relevant term for each state can be found through the Visit Your State map that appears on this page. Statutory language from the 45 states with AOT laws can be found in "State Standards for Assisted Treatment."
Does assisted outpatient treatment take away someone's civil rights?
No. Severe mental illness, not its treatment, restricts civil liberties. By assuring timely and effective intervention for the disabling medical condition of severe mental illness, assisted outpatient treatment restores the capacity to exercise civil liberties and reduces the likelihood of the loss of liberty or life as a result of arrest, incarceration, hospitalization, victimization, suicide and other common outcomes of non-treatment.
What do people who have participated in assisted outpatient treatment SAY about AOT?
Face-to-face interviews conducted by researchers with recipients of AOT in New York found that while the experience of being court-ordered into treatment made about half feel angry or embarrassed at the time of their civil commitment, they overwhelmingly endorsed the effect of the program on their lives after participation.
- 75 percent reported that assisted outpatient treatment helped them gain control over their lives;
- 81 percent said that AOT helped them to get and stay well; and
- 90 percent said AOT made them more likely to keep appointments and take medication.
Subsequent studies have replicated these results.
WHERE IS assisted outpatient treatment available?
Forty-five states currently have assisted outpatient treatment laws. The five that do not are Connecticut, Maryland, Massachusetts, New Mexico, and Tennessee. Additionally, implementation of AOT in the 45 states with laws is often incomplete or inconsistent because of legal, clinical, official or personal barriers to treatment.
Does assisted outpatient treatment work?
Yes. Studies and experiences in Arizona, California, Hawaii, Iowa, New York, North Carolina and other states have documented or illustrated that assisted outpatient treatment works.
Why can't people with severe mental illness be treated in hospitals?
America today is suffering from a severe shortage of psychiatric hospital beds (Treatment Advocacy Center, 2008). Ninety percent of state hospital beds have been eliminated since 1960, and substantial numbers of the surviving beds are now being eliminated or threatened by state budget cuts. As a result, court-ordered hospitalization of people in acute psychiatric crisis in some locations is being delayed by days or even weeks because there are no beds available for them. Once hospitalized, the pressure to move patients out of the bed quickly results in an average hospital stay of 5-6 days, an insufficient period to establish stability.
The Treatment Advocacy Center maintains that people with untreated severe mental illness are entitled to and benefit significantly from treatment before they deteriorate to a point where hospitalization is required. Assisted outpatient treatment is currently the primary means for assuring this happens. (Mental Health Courts also authorize court-ordered treatment but benefit only individuals who have been arrested for a crime. We maintain that people too sick to seek care should not need to commit a crime to receive intervention.)
Is assisted outpatient treatment expensive?
Assisted outpatient treatment is not expensive because it does not mandate any services that individuals with brain disorders are not already entitled to receive. For example, case management, medications and rehabilitation typically already are available to those who qualify for AOT. Counties and states that have actively implemented assisted outpatient treatment typically report that whatever administrative costs it requires are offset by a reduction in costly consequences of non-treatment such as law enforcement involvement, incarceration, hospitalization and/or homelessness.
Is assisted outpatient treatment constitutional?
Yes. Forty-five states and the District of Columbia have assisted outpatient treatment laws, some of them almost 20 years old. AOT laws have been upheld wherever challenged.
Why do so many people with severe mental illnesses go untreated?
Unawareness of illness is found in approximately half of all individuals with severe mental illness, resulting in resistance or rejection of medical treatment. From the point of view of those individuals, why go to medical appointments, take medication or engage in therapy? There's nothing wrong! The term for this condition is "anosognosia" or, more commonly, "lack of insight." Anosognosia is believed to result from changes in the frontal lobes of the brain where information is organized in a way that helps people to interpret experiences.
If reprinted, by permission of the Treatment Advocacy Center