Welcome to the nine-part series on Assisted Outpatient Treatment (AOT) by your friend Kate at the Colorado Mental Wellness Network. The purpose of this series is to shed some light on why it’s still important to be talking about AOT after the passage of the Helping Families in Mental Health Crisis Act (HR 2646). The first part of this series is going to be a bit of background.
HR 2646 was originally introduced over a year ago by Representative Tim Murphy, and the original bill had a lot of issues. It proposed a complete elimination of the Substance Abuse and Mental Health Services administration, alleging that its recovery-oriented approach to mental health treatment was ineffective in treating people with serious mental illness. It sought to expand HIPAA privacy exceptions for people with mental illness to an unreasonable extent. Most hotly debated, it provided financial incentives for states to implement Assisted Outpatient Treatment programs.
Assisted Outpatient Treatment is a euphemism for court-ordered medication regimens. While, theoretically, the programs exist to coerce individuals into comprehensive outpatient treatment that includes but is not limited to medication, the majority of programs consist solely of medication (Spaulding et al. 138). The typical recipients of these court orders are individuals with psychotic disorders who have presented a threat to themselves or others and have continuously failed to maintain a medication regimen on their own terms. It is important to note that, in Colorado and several other states, “dangerous to self” includes functional disability (Treatment Advocacy Center 11-12). Someone who is experiencing homelessness and is unable to consistently feed themselves, for example, may be classified as a harm to themselves.
Proponents of AOT argue that it is in the public interest to prioritize the elimination of potential harm even if it infringes on the rights and liberties of people within that public. Opponents argue the opposite – that the principles of individual liberty, bodily autonomy, and protection of human dignity outweigh the value of preemptive protectionism. Opponents succeeded in gaining revision to HR 2646 on these values, scaling back the bill’s approach to AOT from financial incentive to general increase in funding. Many advocacy organizations were pleased with this, but, frankly, I’m not.
The debate about whether or not to support the practice of AOT shouldn’t be based on values, it should be based on fact. While I fully acknowledge the enticing nature of debate about personal freedom and public safety, it is unlikely to change anybody’s opinion or inform policymakers of best practices in mental healthcare law. That’s what this series is about. I’m going to look at the facts, which suggest that the practice should be discontinued entirely. Tom Burns, the psychiatrist who originally recommended AOT implementation to UK government, has managed to come to this conclusion. He’s called for a suspension of the practice, and I’m calling for the same in the USA (Manning).
Manning, Sanchez. “‘Psychiatric asbos’ were an error says key advisor.” Independent. Independent.co.uk. 13 April 2013. Web.
Spaulding, William D., Elizabeth Cook, and Andrea Avila. “Chapter 5: Therapeutic Jurisprudence and Recovery from Severe and Disabling Mental Illness.” Justice, Conflict and Wellbeing: Multidisciplinary Perspectives. Ed. Brian H. Bornstein and Richard L. Wiener. N.p.: Springer, n.d. N. pag. Web.
Treatment Advocacy Center. State Standards for Assisted Treatment: Civil Commitment Criteria for Inpatient or Outpatient Psychiatric Treatment. Arlington, VA: Treatment Advocacy Center, Oct. 2014. PDF.