Criteria for AOT

Generally, an adult with a mental illness is a candidate for assisted outpatient treatment if they meet one or more of the following criteria. The immediacy of the risk of harm will determine whether hospitalization or AOT is the appropriate course of treatment.

1. The individual can be expected in the near future to seriously physically injure themselves or another person and has previously engaged in acts or made threats that support that expectation.
2. The individual who has mental illness, and as a result of that mental illness is unable to attend to those of his or her basic physical needs such as food, clothing, or shelter that must be attended to in order for the individual to avoid serious harm in the near future, and who has demonstrated that inability by failing to attend to those basic physical needs.
3. The individual’s judgment is impaired by mental illness, lacks an understanding of the need for treatment and demonstrates an unwillingness to voluntarily participate in or adhere to treatment that is necessary to prevent a relapse or harmful deterioration thereby presenting a substantial risk of significant physical or mental harm to the individual or others.

• Read criteria as listed in the mental health code

  330.1401 "Person requiring treatment" defined; exception.

  Sec. 401.

  1.  As used in this chapter, "person requiring treatment" means (a), (b), or (c):
     1. An individual who has mental illness, and who as a result of that mental illness can reasonably be expected within the near future to intentionally or unintentionally seriously physically injure himself, herself, or another individual, and who has engaged in an act or acts or made significant threats that are substantially supportive of the expectation.
     2. An individual who has mental illness, and who as a result of that mental illness is unable to attend to those of his or her basic physical needs such as food, clothing, or shelter that must be attended to in order for the individual to avoid serious harm in the near future, and who has demonstrated that inability by failing to attend to those basic physical needs.
     3. An individual who has mental illness, whose judgment is so impaired by that mental illness, and whose lack of understanding of the need for treatment has caused him or her to demonstrate an unwillingness to voluntarily participate in or adhere to treatment that is necessary, on the basis of competent clinical opinion, to prevent a relapse or harmful deterioration of his or her condition, and presents a substantial risk of significant physical or mental harm to the individual or others.
  2. An individual whose mental processes have been weakened or impaired by a dementia, an individual with a primary diagnosis of epilepsy, or an individual with alcoholism or other drug dependence is not a person requiring treatment under this chapter unless the individual also meets the criteria specified in subsection (1). An individual described in this subsection may be hospitalized under the informal or formal voluntary hospitalization provisions of this chapter if he or she is considered clinically suitable for hospitalization by the hospital director.
• Listen to Judge Milt Mack (ret.) explain the mental health code
  Watch the full training video

Clinical assessment

Clinical assessment is an important part of the assisted outpatient treatment process. In cases where an individual has not previously received a psychiatric evaluation, one is conducted before the order is issued. Further, clinicians (often from the Community Mental Health agency) testify in court to the individual's condition and make treatment recommendations. 

AOT success: research and best practices

• It is best to intervene as soon as possible, the closer to the onset of a person’s mental illness, the better their chances of success with the proper treatment and interventions.
• Research has demonstrated that AOT is most effective for individuals with schizophrenia or bipolar disorder due to a symptom of their illness being a lack of insight into a need for treatment.
• AOT works best when there are adequate community resources and support services available.
• Though it is best to try AOT closer to the onset of an individual’s serious mental illness, it is best to try less restrictive options first.

Who is AOT not for?

• AOT is not appropriate for individuals whose primary diagnosis is substance use disorder without any co-occurring serious mental illness.
• Those whose primary diagnosis is a neurological condition such as dementia, who would not be able to live independently in the community.
• Individuals who function independently in the community – even if they do have serious mental illness.
• Those who have allergies or medical conditions that would prevent the use of psychiatric medications.

How is guardianship different from assisted outpatient treatment?

Guardianship is different from AOT in a few ways, as outlined in the table below. However, guardians can play a role in AOT, either by petitioning for AOT, or supporting their ward through the process and advocating when there may be a need.