by Kate Fitch
One major emphasis in the Helping Families in Mental Health Crisis Act is the increase in funding toward, and financial incentive to States for implementing, “Assisted Outpatient Treatment.” This is less euphemistically known as Involuntary Outpatient Commitment. AOT is not a proven, evidence-based practice. Let’s compare it to Assertive Community Treatment, a voluntary, person-first practice listed on SAMHSA’s National Registry of Evidence-Based Programs and Practices.
ACT is a voluntary outpatient assistance practice that utilizes comprehensive services to help individuals with mental illness live in their communities of choice. It also has a large body of research backing its effectiveness. Studies show that:
- ACT participants are more likely to hold paid employment than non-participants
- ACT participants are rated as “performing more effectively in their work role[s]” than non-participants
- ACT has “consistently [been] found effective in decreasing hospital days.”
- Improvements made in ACT are maintained when patients are discharged to less intensive services.
AOT, on the other hand, is a practice mandating patients to outpatient treatment, including medication regimens, without any further specification of what that treatment entails. Research has shown that:
- AOT orders make no statistically significant difference in symptom remission
- AOT orders cause significant feelings of anger and embarrassment in up to 50% of individuals
- AOT orders are only very slightly more effective than voluntary treatment for a very small subset of individuals to whom the orders are applied.
So, why on earth is AOT the only practice named in the Murphy Bill??
Dixon, L.B. and E.C. Schwarz. “Fifty years of progress in community mental health in the US: the growth of evidence-based practices.” Epidemiology and Psychiatric Sciences 23.1 (2014): 5-9
Hackman, Ann L. and Keith R. Stowell. “Transitioning Clients from Assertive Community Treatment to Traditional Mental Health Services.” Community Mental Health Journal 45 (2009): 1-5
Swartz, Marvin S. and Jeffrey W. Swanson. “Involuntary Outpatient Commitment, Community Treatment Orders, and Assisted Outpatient Treatment: What’s in the Data?” Canadian Journal of Psychiatry 49.9 (2004): 585-591