Assisted outpatient treatment (AOT) is a legal mechanism for providing outpatient treatment to individuals living with serious mental illness (SMI) whose non-adherence places them at risk for negative outcomes. It is an evidence-based tool that promotes recovery, reduces harmful behavior, hospitalization and emergency room use as well as reducing costs. AOT works by compelling the recipient to receive specific treatment that will prevent their condition from worsening and by committing the mental health system to provide treatment. 

Michigan has some of the best laws in the nation for assisted outpatient treatment (AOT). Effective AOT programs and systems will help ensure individuals receive high-quality services in the community and work toward transitioning back to voluntary care. Every part of the system of care plays a uniquely important role in an effective AOT program, including courts, mental health providers, hospitals, families and advocates, individuals, and law enforcement. 

Learn more about each component of the system of care

History of AOT in Michigan

Assisted outpatient treatment in Michigan law began as a package of bills called "Kevin's Law". Kevin Heisinger, a 24-year-old student at U of M, was killed in a Kalamazoo bus station by Brian Williams, an individual living with schizophrenia (paranoid type) in 2000. Prior to killing Kevin, Williams had repeated contact with law enforcement and numerous psychiatric hospitalizations due to his non-adherence with psychiatric treatment. In response, the Michigan Legislature passed assisted outpatient legislation dubbed "Kevin's Law" which went into effect in 2005.  

AOT laws are a part of the mental health code, a compilation of Michigan laws governing the delivery of mental health services. AOT laws were revised in 2017 & 2019, bringing the law up to date with best practices. Changes made to the law permit earlier intervention by eliminating the "threat of imminent harm and danger to self or others". Additionally, updates provided a new process to secure outpatient treatment without hospitalization, and introduced mediation to gain adherence to treatment.

To learn more about the history of AOT in Michigan, check out the Courts training videos.

About this toolkit

The Assisted Outpatient Treatment (AOT) toolkit is an evidence-based tool that promotes recovery and reduces harmful behavior, hospitalization, emergency room use, and costs. The toolkit strives to improve the practice of providing outpatient treatment under civil court order to individuals with SMI who have demonstrated difficulty engaging with treatment on a voluntary basis. When systematically implemented and adequately resourced, AOT can dramatically reduce hospitalization, criminalization and other adverse outcomes for its target population. The toolkit aims to provide general information about the process of AOT and more specific guidance for key components of the system: courts, mental health providers, hospitals (including emergency rooms and inpatient psychiatric care), individuals under AOT orders, families and advocates, and law enforcement. 

In 2020, the Treatment Advocacy Center ranked the quality of Michigan's laws that provide for involuntary treatment of psychiatric illness as third in the country, with AOT laws among the top five in the country. However, measures of mental illness identification, treatment, and diversion leave much to be desired. Michigan is #47 in public psychiatric beds per capita and #35 in criminal diversion. For every one person with SMI that is hospitalized in Michigan, there are 4.3 people incarcerated. This toolkit strives to provide tools to improve the implementation of AOT and improve our state's response to mental illness. 

Partners and contributors

This toolkit is funded by the Michigan Department of Health and Human Services Mental Health Diversion Council. Content is coordinated by the Center for Behavioral Health and Justice and the AOT Workgroup of the MHDC. 

This toolkit has been developed in collaboration and partnership with a number of individuals and agencies. 

Mental Health Diversion Council and AOT Workgroup members

Special thanks to Diversion Council members Kevin Fischer, Lauren LaPine, Hon. Milton L. Mack, Jr. (Chair), Steven Mays (Diversion Administrator), Dr. Debra A. Pinals, and Bob Sheehan.

Content contributors 

Project partners 

The CBHJ would like to thank the Treatment Advocacy Center for their work in making AOT a routine practice of every local mental health system, which has greatly informed this toolkit. 

We would also like to extend our gratitude to those who have attended the webinars and submitted feedback and questions, as this has helped inform the current and futute content of this toolkit.