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 courts?

Effective implementation of AOT orders gives the court a unique opportunity to improve the lives of people with SMI who are not compliant with treatment and stop the revolving door of frequent hospitalization and incarceration. The court's oversight role provides structured accountability for both the community treatment provider and the individual under an AOT order. A combined AOT and hospitalization order ensures that treatment will be continued in the community upon discharge from the hospital.  An AOT only order allows concerned parties (for example, families or treatment providers) a mechanism to intervene prior to a crisis episode, potentially avoiding inpatient hospitalization or dangerous interactions with law enforcement. 

Research on the efficacy of AOT has found individuals on an AOT order experience significant reductions in various adverse events such as harm to self or others, frequent hospital visits and encounters with law enforcement. These individual quality of life improvements, in turn, benefit the larger community by decreasing the stress on hospital EDs  and reducing the need for law enforcement responses to mental health crisis calls. Implementing AOT can create positive systemic change with significant cost savings.

Action steps for courts:

• Train all staff on eligibility for AOT and treatment services appropriate and available.  Invite CMH providers to conduct training on mental health and services.
• Develop internal policy and procedure detailing how to implement AOT in your court.
• Designate specific staff members to implement an AOT program within your court.
• Work with community mental health authority to coordinate AOT implementation in your community. Designate a liaison from each organization to facilitate communication, coordination and information sharing.
• Collect data to evaluate AOT implementation.