Assisted Outpatient Treatment is an attempt to stop the revolving door of hospitalization-release-hospitalization-release for some people with mental illness. This court-ordered treatment is usually for individuals with mental illness who have a pattern of noncompliance with medication.

The first Assisted Outpatient Treatment law, called Kendra’s Law, was in New York. It became law after a person with untreated several mental illness killed Kendra Webdale by pushing her in front of a subway train in 1999.

Some form of this law is on the books in 47 states and the District of Columbia, but it’s not really available everywhere that it’s legal. Connecticut, Maryland and Massachusetts do not have Assisted Outpatient Treatment at all. If you live in any other state, the Treatment Advocacy Center can provide information about your state’s resources.

Since I live in Ohio, I am going to quote from my state’s Civil Commitment criteria (State law 5122.01 (8) (1) to (5). Mentally ill individuals can be subject to court-ordered treatment if they:

• Represent substantial risk of physical harm to themselves or others OR
• Are unable to provide for their own basic physical needs OR
• Have behaviors that create grave and imminent risk to the rights of themselves or others.
• Are unlikely to survive safely in the community without supervision.
• Have a history of treatment non-adherence that has led to either:
  • Two hospitalizations in the last 36 months spent in the community OR
  • An act/threat/attempt of serious violence in the last eight months spent in the community
• Are unlikely to voluntarily participate in treatment
• Need treatment to prevent relapse or deterioration likely to result in substantial risk of serious harm.

A judge orders Assisted Outpatient Treatment in civil court. The judge also becomes the primary motivator due to the Black Robe Effect. Because they command respect as a symbol of authority, the judge motivates both the treatment system and the individual. Treatment usually takes 12 to 18 months.

If either the treatment professionals or the individual do not adhere to the treatment plan, the judge can:

• Extend the length of time in the program.
• Increase the frequency of appearance in court.
• Order reviews of the treatment program.
• Pick up the individual for evaluation.
• Rehospitalize the individual.

Pathways to Getting Assisted Outpatient Treatment

The best way to get someone into the Assisted Outpatient Treatment program is to start talking to doctors when a loved one is in the hospital, especially if the loved one has had an involuntary hospitalization. Ask the doctor to file an affidavit with the court requesting Assistant Outpatient Treatment. Family members also can file an affidavit for mental illness treatment at the probate court.

Another good time is during a transition from jail or prison to the community. Ask the doctor at the jail to initiate this.

Assisted Outpatient Treatment works. The program began in New York, where it is used most extensively. Study results show that those in the program has a 87% decrease in incarceration, a 74% decrease in homelessness, an 83% decrease in arrests and a 77% decrease in rehospitalizations. More information is available from the Treatment Advocacy Center.