Assisted outpatient treatment (AOT) is finally coming into its own. After so many people fighting for the rights of the seriously mentally ill for a decade, this lifesaving treatment option is finally available in the vast majority of states. But many people feel that assisted outpatient treatment denies civil liberties. I would argue, however, assisted outpatient treatment actually upholds civil liberties, not to mention upholds societal ethics.
What Is Assisted Outpatient Treatment (AOT)?
Assisted outpatient treatment is court-ordered and court-supervised treatment of severe mental illness in a tiny percentage of people who live in the community. In short, if you have a person who repeatedly is arrested or hospitalized for a severe mental illness, refuses to take medication and is a danger to themselves or others without it, the county mental health department can file a petition to the court for AOT.
Assisted outpatient treatment cannot force a person to take medication, but, rather, enforces a treatment plan. But, as most of us know, a treatment plan normally consists of medication along with other steps. However, the taking of this medication, according to Psychiatric Times, “. . . relies on ‘the compulsion generally felt by law-abiding citizens to obey court directives,’ not force.”
The lack of reliance on force is just one of the reasons that AOT does not violate civil liberties.
What Are Civil Liberties Related to AOT?
Some people would argue that anyone, anywhere, anytime has the right to refuse treatment.
Well, I suppose that’s true.
Anyone, anywhere, anytime has the right to be arrested for their mentally ill behavior. Anyone, anywhere, anytime, has the right to be forcibly hospitalized for their mentally ill behavior. Anyone, anywhere, anytime has the right to live on the streets and eat out of garbage cans because of their mentally ill behavior.
The question is, do we want to live in a society where being imprisoned, being hospitalized and eating out of garbage cans is preferable to a treatment plan created by professionals? Because I certainly do not. Moreover, I would argue it is a civil liberty not to live like that. We should all have the right to be well – not to remain sick. We should all have the right to a life outside of incarcerations and hospitalizations and with food and shelter. And AOT allows for this. It allows for people to live in the community in a safe and stable way. If I were ever so sick that I couldn’t understand my own illness, was living on the streets, was getting arrested and was getting hospitalized, I pray to god that someone would give me AOT.
What Is Some People’s Problem with AOT?
But no matter how much sense this makes, no matter how the data shows that AOT prevents homelessness, violence, drug abuse, psychiatrist admissions and arrests, people still scream “HUMAN RIGHTS VIOLATIONS!”
This is so ridiculous.
While I can understand the need for oversight, while I can understand the need for judiciousness in application, and while I can even understand some reticence, what I can’t understand is denial of this very important program that will help a small, but critically ill, number of people. If anything, more people need this program, not less.
I believe we live in a society where it’s our job to protect each other and particularly protect those who can’t protect themselves. And that is what AOT does. Assisted outpatient treatment preserves the civil liberty for safety, sanity and a life. Denying these rights is something that opponents do.
Reference: Assisted Outpatient Treatment Enters the Mainstream by By E. Fuller Torrey, MD and John D. Snook, JD
Banner image care of the Department of Defense.
Good day! Respectfully saying I passed some of your articles to a friend of mine on Discord who then replied:
I mean, I was misdiagnosed as bipolar, forced on meds for literally years. I was put on pretty much every bipolar med — both on and off label ones — and none of the meds ever did anything at all, other than give me more opportunities to hoard pills to overdose on.
That is essentially why she said she is against forced medication. Any thoughts?
That being said, thank you so much for your writings! I remember commenting here before when I was in the throes of a severe episode and really, this blog got me through it. I hope to become a licensed MD soon. More power!
“Forced drugging doesn’t deny liberty”
Even for you, this is some peak psychiatric newspeak.
If you want to give the quacks the ability to decide you have no right to your own brain, and boot in your door in order to have you hauled down to the psych center to be filled full of neuroleptics or have an electricity induced TBI, that’s on you.
Some of us actually like having freedom.
AOT -is- forced drugging, doesn’t work, and it’s a form a torture. You’;re basically using your mislaced or put-pn sense of concern to justify robbing people of their indvidual liberty. We fought world war 2 to keep types like you from power.
“..I do know that not having AOT options available when they could help someone is cruel, and I suspect the majority of people arguing against any AOT are the same ones arguing against any involuntary hospitalization whatsoever, i.e. extremists…” Mark Roseman
“..Of course, not repealing the ACA would have saved millions more people — but he voted to repeal it. Because, in America, it isn’t about saving lives. It’s about money and politics…” Gabe Howard
I have little idea what assisted outpatient treatment option is in most of the world… I do know, in NC (my state), there is NO Assisted Outpatient Treatment that involuntarily (on client, not patient) forces a person to have injected medication into their systems… be they funded, or not.
Now… I do know of Assisted Outpatient Treatment of which the person voluntarily admits themselves into a assisted program for which daily living activities are taught (money handling, cooking, circumventing the transportation system, etc.) and do meet with a medical staff person as well as their case worker on a day by day basis (5 days a week) and has emergency crisis folks (case worker, medical staff or trained peer support) folks on “the weekends”. The medical staff does fix the medication pill boxes weekly for the clients, caseworker takes them to appointments if necessary, etc.
none that actually involuntarily forces one to consume their prescribed medication….
That is housed and performed in “hospitals” and is legally mandated, by law…
that doesn’t make me a extremist…. I do not want to find myself (or anyone else) being involuntarily medicated by a system receiving only governmental funding, at best… because I might present in a crisis mode but not a danger to anyone, including myself… but because I have Bipolar (a severe and persistent mental illness with bouts of de-compensating) it was deemed valid to force me, involuntarily…
The ACA… oh please.
I am currently without ANY health insurance. My state didn’t expand Medicaid to more, potentially eligible, people.
I am penalized, via tax return, if I do not carry basic minimum health insurance on myself through a website, called “the exchange”. There is, I believe, 1 insurer left in my state… BCBS who raises the rates exponentially cause it’s a losing game to them.
I cannot afford the coverage. The basic, cheapest coverage will cost me $97 a month. Sounds awesome.. until you are hit with a $5600 (or more) Deductible that must be met BEFORE anything kicks in, coverage wise, including prescriptions.
Which means; yes, I can get a mammogram for free (government mandated free service) but I can’t see my psychiatrist (or neurologist or gastroenterologist, etc.) or take the meds (or diagnostic treatments) he/she prescribes
because while I am impoverished, I am not impoverished “enough” on welfare or SSDI’d Medicare for eligibility for medicaid that does actually exist.
Now… you potentially expand Medicaid… Okay, sounds awesome.
Until you find that there are very few providers of care, be it medical or mental, that actually accepts Medicaid. Why? Cause reimbursement rates are pathetic AND because it is state/federally funded… it requires a tremendous amount of paperwork for each service and not all services, are covered.
Still, better than not having any at all. Gotcha.
Take into account that many, who get ACA coverage, do not keep their coverage month after month… providers of care lose out in accepting because they never know as to which month the client/patient failed to make their premium payments until 90 days later….
I’ve worked for the providers of care and I’ve worked for the health insurers and I’ve dealt with Medicaid, as a employee in a provider of care and I’ve been the one chasing and tracking down patients who had ACA coverage one month but it was dropped the next but the provider of care wasn’t notified until 60-90 days out…
oh… and don’t get me started on how the ACA screwed the rank and file american worker by allowing employers to drop their full-time payroll to primarily part-time… which also lowered the hourly wage cause it’s so much cheaper to get 2 employees for the price of 1.
now… I have stepped down off my soapbox and will proceed to trying to find me a job… granted only 16-25 hours a week at minimum wages with absolutely NO health care coverage much less any sick day coverage… but will proceed to try to find me one…
thank you!
I don’t think rights are ever absolute, and that admitting that forced/coerced treatment may to some degree infringe rights doesn’t render it invalid. There’s a good argument to be made that it can protect different sets of rights, and there are also utilitarian arguments (utility both for the patient and for others) in favour of it. All of these mechanisms are inherently a balancing act, and there’s rarely an obvious place to draw the line. It’s messy.
I do know that not having AOT options available when they could help someone is cruel, and I suspect the majority of people arguing against any AOT are the same ones arguing against any involuntary hospitalization whatsoever, i.e. extremists.
people don’t like the idea of being forced to take toxic drugs, jsut as uch as they hate the idea of being forced into a prison masquerading as a medical facility.
Go figure, sorry about your friend [moderated]
Hello, Mr. Friendly,
Please don’t call people names. It’s against the commenting rules and I don’t like it.
– Natasha Tracy
And some people when they’re well would want to know that if they ended up very sick they’d be given certain drugs even if they argue they don’t want them at the time… and after they’re well again they are glad someone gave them those drugs that they were fighting against at the time. Emphasis on SOME people. Like I said, balancing act.
“well” in this sense being a drooling neruoleptic zombie. Sorry you like being a subjugated lab rat with no real freedom, some of us are human beings not obedient slaves thankful for their massa’s plantation.
if you think forcing dangerous, ineffective sedatives on people because some quack decides they don’t like their attitude, you’re either a monster or a sadist or both. Which is it?
Mr. Friendly,
Please try to keep your comments respectful. There is no need to call another commenter names.
– Natasha Tracy
Hi Natasha –
Long time reader, first time commenter. :-)
AOT, in theory, can be a good thing. I have little to say on the subject except that not everything named “AOT” is, in fact, create equal.
In Ohio, for example, we have AOT but literally no funding to go with it. So while the laws are on the books, no one can legally enforce them because advocates spent years and hundreds of thousands of dollars fighting for a law rather than funding or additional beds.
So, we have people who WANT treatment. They WANT to be med compliant. They WANT to get better. But, few resources to give them. So, they are left homeless and sick with no resources.
But, you are correct, the law is on the books.
My issue with these laws has always been that they are often incomplete. They don’t include funding, oversight, and are often sold to a community on the idea that these laws curb violence.
One just need to take a look at Rep Murphy (R-PA) to see this play out. He was in the media touting that his law would prevent school shootings, curb violence, and save lives.
Of course, not repealing the ACA would have saved millions more people — but he voted to repeal it. Because, in America, it isn’t about saving lives. It’s about money and politics.
It’s a political move to show the voters you’ve done something about gun violence. . .
. . . without actually doing anything about gun violence.
The mentally ill are scapegoats once again.
That said, AOT has been rolled out effectively in many communities — not most, just a handful — and in those cases, AOT is a godsend.
But, mostly it is just smoke and mirrors.
Like in Ohio, where I live.
Gabe :-)
“Hi Mike,
The whole point is that it’s _community_ treatment — as in, it gets people _out_ of those facilities.
– Natasha Tracy”
Back in the day, not too many days ago…. many of the mentally ill, in the USA, were often FORCED into institutions. Some of those institutions were awesome… many moreso, were just buildings that housed the mentally ill as well as those deemed “retarded” or “not right”.
Horrible experimental treatments befell many.. because well, psychiatry was experimental and the patients were either brought by family or placed by law enforcement. We then had a spell where the government decided to move all those deemed “eligible” to the communities for the community to care for them.. and thus, community agencies were formed. Yet, many of those rely solely on government funding and some mis-approprate and misuse… thus, little quality conscious community agencies… thus, homelessness and drug addiction, etc. grows
If one is “required and mandated” to receive psychotropic care… it is not primarily via community, it is primarily via facility.
Each human being should have the right to their own bodies Natasha… to their own organs.
To force someone to undergo treatment; often ECT or lobotomies and high powered anti-psychotics, etc. when psychiatry is still a “experimental” science (again, no medical diagnostic tool or even a concrete list of symptoms directly diagnosing any one illness… cause many illnesses mimic other illnesses or can be cross-diagnosed to other illnesses and EVEN known “medical” disorders)….
is TO ME, to be, edging on the likened forced sterilization that happened to many with mental illness or deemed “unfit” or “retarded” or of a grossly lower socio-economic class of folks. Or the dictation of what women can and cannot do to their own bodies cause argument used to be that women had no intelligence or insight in those matters, as well.
I do believe ..all that said
that if someone is truly psychotic and is a determined threat to themselves and more importantly, others… and are legally committed to a facility of whatever kind…. then yes, forced medication/treatment is a go
Tabby. I fully understand, but it can only be community-based if the community has funds. First thing states and communities do when their balance sheets look horrible is cut funding to social-based programs in order to fund day to day operations. That’s an undeniable fact.
With all due respect, you live in Canada. Come here and visit these so called facilities. I live north of a major metro and there are none and if there were they are closed down. Most states are in the red and the first things to go are social services and many mental health facilities are bought up by for private companies that expect payment and if for some form of luck you have mental health care as part of a policy you may get 5 days worth of treatment. And I would gather 90 percent of them are for addiction related services. Our facilities around here are prisons where half the prison population shouldn’t be there because they suffer from severe mental health issues and the hospitals are worthless. As you say this is court ordered and yet you say its for a tiny portion of the population. The rest may languish in prison forever. The system is broken to the core.
Hi Mike,
The whole point is that it’s _community_ treatment — as in, it gets people _out_ of those facilities.
– Natasha Tracy
yes, no need for the prison when the drugs and knowing you can be at the receiving end of a needle and cops at the drop of hat creates a prison in your own head.