A way out of the revolving door

Michael Gray

Michael Gray

New treatment method gives mentally ill a chance at recovery while living independently, with family or in supportive housing.

There are a variety of treatment options for severe and persistent mental illness, but many people experience symptoms so great they are unable to access healthcare services voluntarily. They often end up homeless, incarcerated or involuntarily hospitalized, none of which provide long-term solutions to their symptoms or treatment for their illness.

Assisted outpatient treatment (AOT) should be an alternative to those worse-case scenarios. It allows people who would otherwise cycle in and out of the criminal justice system and short-term hospital stays to receive long-term treatment while remaining in the community. 

Community Based Option

AOT is a process where a person’s family, friends and mental health providers can work with the court system to determine the least restrictive means of treatment. It is only suited for people who have the most severe symptoms of mental illness and are often unaware that they need treatment.

Without intervention by their families and the courts, these individuals can end up homeless, incarcerated or victimized as a result of their symptoms. AOT provides a way out of the revolving door of ineffective outcomes by taking patients out of this cycle and giving them a chance at recovery while living on their own, with family or in supportive housing. 

A Better Way

Kentucky already has a law in place for voluntary court-ordered outpatient treatment, but several advocates around the Commonwealth and many legislators want to see a mechanism like Laura’s Law in California or Kendra’s Law in New York for involuntary outpatient treatment.

According to the Treatment Advocacy Center, people with severe mental illness who received court ordered treatment plans under the New York law saw 77 percent fewer hospitalizations, 83 percent fewer arrests and a 74 percent drop in homelessness.

In states that allow AOT, family, friends or a mental health provider requests that a court hold a hearing and determine whether a person meets specific criteria for AOT. If so, the court can bring everyone who cares for the person or treats his or her illness into a collaborative effort and devise a treatment plan.

The AOT legislation under consideration in Kentucky’s General Assembly this year, House Bill 65, provides a list of criteria that must be met in order to put a treatment plan in place. It requires that a person, if untreated, will:

  • Pose a threat of danger to his/herself or others.
  • Experience severe mental, emotional or physical harm.
  • Have significantly impaired judgment, reasoning, functioning or capacity to recognize reality.
  • Have a diminished ability to make decisions regarding his or her need for sustained medical treatment.

Someone who meets these criteria has a high risk of cycling through our jails and hospitals unless their families and healthcare professionals obtain an AOT plan.

Patient Rights 

For AOT to be effective, enabling legislation must outline a practical procedure and safeguard the rights of people who stand to benefit from it. Advocates for people living with mental illness often complain that court ordered treatments can deprive them of civil rights.

This is a valid concern, but well-drafted legislation can avoid any undue deprivation of rights by requiring the following:

  • The patient has an attorney present during all discussions related to the treatment plan.
  • Allowing a peer support specialist to be present during the entire process.
  • Requiring a high burden of proof for any parties seeking a court order.
  • Providing criminal penalties for anyone who takes out a false petition for AOT proceedings.

Of all of these safeguards, requiring the presence of an attorney and penalizing anyone who seeks a court order under false pretenses are the strongest guarantees that AOT proceedings will not trample a patient’s rights. The incentive to take out a petition should be a genuine desire to get someone the treatment they need.

Implementing an AOT

Implementation of AOT must also be practical. It must include the right personnel and it should have criteria for treatment that are realistic and applicable to the patients who need it.

The team of people responsible for implementing an AOT plan should include case management to ensure that mental health professionals, family members, peer support specialists, and everyone else involved in the process adhere to the plan.

Community based outpatient treatment can provide a lifeline to families who are desperate to keep their loved ones with severe mental illness out of hospitals, jails, or homelessness. If it is implemented in a way that avoids unnecessary deprivation of rights and provides fair criteria, Kentucky needs AOT as an option for treatment of severe mental illness.

Michael Gray is executive director of NAMI Louisville.



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