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Many individuals living with serious mental illness (SMI) do not adhere to outpatient treatment for a variety of reasons, increasing their risk for suicide and self-harm, violent behavior, substance misuse, insecure housing, high utilization of ERs, and frequent contact with law enforcement. These behaviors lead to high rates of inpatient psychiatric hospitalization and incarceration.

Assisted outpatient treatment (AOT) is a legal mechanism for providing outpatient treatment to individuals living with SMI whose non-adherence places them at risk for negative outcomes. AOT orders work 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.

Why does AOT matter to families and advocates?

More than 1 in 20 adults in the US live with serious mental illness, and the challenges they face are shared with those who love them. There are close to 8.5 million adults providing care for adults living with SMI, and for many of them is it a full-time job. One of the most challenging aspects families and advocates face in their efforts to support these adults is getting their loved one the right treatment, especially given the reality that anywhere from 50-95% of adults living with an SMI do not recognize they are ill, leading to non-compliance with treatment. Treatment non-compliance leads to a host of adverse events, including homelessness, suicidal behavior, substance use, violence, and incarceration. Families and advocates know the pain and sense of helplessness that comes with watching loved ones deteriorate without treatment.

AOT was designed to address the problem of treatment non-compliance arising from SMI and accomplishes this goal in two ways. First, it holds the individual accountable for participating in treatment, supplementing the efforts of families and advocates by adding the support of the probate court.

Second, it holds treatment providers accountable for providing treatment by monitoring the individual's progress. Research has shown that AOT is effective at reducing many of the adverse outcomes associated with untreated SMI, including hospitalizations, suicidal behavior, violent behavior, alcohol use, drug use. Even more importantly, it allows individuals to reach their potential, less encumbered by their illness.

Action steps for families and advocates:

• Learn more about AOT, how to file, and whether your loved one is a good candidate.
• Get support for yourselves – the National Alliance on Mental Illness offers a wide range of support options to assist you and your loved one.