Assisted Outpatient Treatment (AOT)


Assisted Outpatient Treatment (AOT, formerly known as involuntary outpatient commitment (IOC), allows courts to order certain individuals with brain disorders to comply with treatment while living in the community.

Assisted Outpatient treatment was initially proposed in the early 1980’s by families of individuals with the most serious mental illnesses as a way to help their loved ones. Individuals with disorders like schizophrenia often need medicines to enable them to control their own thoughts and behavior. But sometimes, they don’t recognize they are ill (“Anosognosia”) and therefore see no need to be in treatment.

These individuals often decompensate, commit suicide; become mentally ill homeless; end up in jail; or, on rare occasions, are involved in acts of violence because of mental illness. Family members and caregivers were not allowed to intervene until ‘after’ the individual “became danger to self or others”. Many felt the law should prevent dangerousness, rather than require it.

Once the family member deteriorated to the point of dangerousness, the only thing police could do was involuntarily commit the individual to inpatient hospitalization.

Families believed that committing someone to receive services on an outpatient basis was kinder, more humane and less expensive than inpatient. In addition, it could prevent the person from deteriorating in the first place.

AOT is no an alternative to voluntary services. It is a way to see that services get utilized by those who reject voluntary services and are likely to needlessly decompensate as a result.

Assisted Outpatient Treatment is an important advance.

  • 1. AOT allows individuals to be court-ordered into treatment without ordering them into a hospital. It is a less-restrictive, less-expensive, more humane form of ‘commitment’ than inpatient commitment.
  • 2. The criteria to place someone in assisted outpatient treatment are easier to meet than the “imminent dangerousness” standard often required for inpatient commitment. AOT allows someone to be ordered into treatment “to prevent a relapse which or deterioration which would likely result in serious harm to the patient or others.” Prior law required ‘dangerousness’, Assisted Outpatient Treatment prevents it.
  • 3. The court order not only commits the patient to accept treatment, the court order also commits the mental health system to providing it. Prior to AOT, many treatment providers preferred to exclude the most seriously ill.

The only service the patient must be mandated to accept is case management. All other services, including medication compliance, are the discretion of courts. The law includes strict eligibility criteria and numerous consumer protections. Research shows Assisted Outpatient Treatment:

  • Helps the mentally ill by reducing homelessness (74%); suicide attempts (55%); and substance abuse (48%).
  • Keeps the public safer by reducing physical harm to others (47%) and property destruction (46%).
  • Saves money by reducing hospitalization (77%); arrests (83%); and incarceration (87%).
DJ Jaffe is Executive Director of the non-partisan Mental Illness Policy Org., and author of Insane Consequences: How the Mental Health Industry Fails the Mentally Ill. He is a critic of the mental health industry for ignoring the seriously ill, and has been advocating for better treatment for individuals with serious mental illness for over 30 years. He has written op-eds on the intersection of mental health and criminal justice policy for the New York Times, Wall St. Journal and the Washington Post. New York Magazine has credited him with being the driving force behind the passage of New York’s Kendra’s Law and Congress incorporated ideas proposed by DJ in the Helping Families in Mental Health Crisis Act.