Many individuals living with a serious mental illness (SMI) do not adhere to outpatient treatment, often resulting in increased rates of suicide and self-harm, violent behavior, insecure housing, high utilization of ERs, and frequent contact with law enforcement. These behaviors and vulnerabilities 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 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. AOT orders allow concerned parties (such as families and treatment providers) to intervene on behalf of an individual living with an SMI without having to wait until that individual reaches a crisis, increasing the individual's ability to function in the community.
Why does AOT matter to law enforcement?
Law enforcement officers are increasingly called upon to respond to calls involving people with mental illness. People living with serious mental illness, such as schizophrenia or bipolar II disorder, are less likely than those with mild or moderate mental health concerns to recognize they have an illness, to seek treatment or to adhere with existing treatment. When untreated, serious mental illness contributes to increased rates of violent behaviors, suicidal and self-harming behaviors, substance use, homelessness, and frequent ER visits. AOT provides a way to compel an individual to receive the help they need.
Unlike hospitalization, AOT can be utilized prior to a crisis, keeping the individual, the community, and law enforcement officers safer. Anyone can petition the court for an AOT, including law enforcement, with the same form used for hospitalization. Even when law enforcement is not involved in originating the order, they play an important role in the process by executing Orders for Transport issued by the court, taking an individual into protective custody for transport to a local ER or crisis center for a mental health assessment.
- Execute orders for examination and transport (PCM 209a).
Action steps for law enforcement:
- Train staff on who is eligible for AOT, how to file, and transport orders.
- Identify people with frequent law enforcement contacts who may be eligible for AOT.
- Designate Crisis Intervention Team trained staff or officers with additional mental health training to conduct transport orders.
- Work with the community mental health authority to follow-up on people with AOTs in the community.
Frequently asked questions for law enforcement
- We get a significant number of Mental Health pick up Orders for individuals who are compliant and have adequate transportation means with either their AFC home or guardian. Is there a reason that LE has to get involved?
An Order for Examination/ Transport (PCM 209a) (often referred to as a “transport order”) is issued by a judge when there is compelling evidence that an individual needs to be evaluated for treatment. This may happen in a variety of circumstances, such as when a family member cannot convince a loved one to go get an evaluation or when someone on an AOT has become non-adherent with their treatment. Often, the person living with a Serious Mental Illness will change their perception of needing treatment when law enforcement is present, leading to situations where law enforcement may not recognize the person’s need for mental health treatment. Since the Order for Examination/ Transport is an order issued by the judge, law enforcement should treat it like they would any other judicial order (e.g., a warrant).