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Lack of Implementation

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Untreated severe mental illness and its negative consequences persist despite the existence of assisted outpatient treatment (AOT) laws in 45 states and progressive civil commitment standards in 26 states. In virtually every state, implementation of existing laws and standards is inconsistent at best and nonexistent at worst. Common obstacles to the use of existing laws and standards include: 

Legal barriers

•    Incomplete or inconsistent understanding of how the laws and standards work
•    Inconsistent application by judges
•    Inadequate enforcement of court orders

Clinical barriers

•    Hospitals, physicians and mental health professionals who are unaware of the laws and/or don’t know how to use them
•    Identification mechanisms that would enable hospital emergency rooms, law enforcement and others to immediately recognize individuals under court-ordered outpatient treatment 

Official barriers

•    Perceived or projected fiscal impacts on local government
•    Shortage of public personnel with knowledge or training in implementing the laws
•    Opposition by the mental health officials charged with implementing the laws and standards
•    Opposition from tax-funded protection and advocacy (P&A) groups 

Personal barriers

•    HIPAA/confidentiality obstacles
•    Absence of committed or informed family members to act as advocates
•    Perceived civil rights issues

States whose civil commitment standards do not currently include the need for treatment are shown below in gray.
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