Court mandated Mental Health treatment and/or Assisted Out Patient Treatment known as AOT is a hotly contested topic in recovery and on a larger level mental hygiene law. I have had the experience of working with adults with an AOT order from the court and continue to have mixed feelings about the clinical value of mandated treatment for people with severe and persistent mental health diagnoses. This article aims to re-purpose and further explore possibilities in which AOT orders can be handed out by the court and by the practitioners that must carry out the order. As this article unfolds, various AOT order related features that maintain its power to keep people in treatment regardless of their participation will be evaluated such as the notorious Out Patient Pickup when patients are non compliant and taken to the hospital by police as well as 939/940 order when a persons home can be entered to evacuate them to the hospital for an emergency admission.
AOT orders require practitioners, clinics and ACT teams to evaluate their patients compliance monthly in several areas of treatment. These include adherence to medication, participation in treatment, safety, and level of risk of hospital re admission. The problem here is that despite these areas being evaluated clinically there are still grey areas which many practitioners fail to include in their assessment. The biggest area of concern is medication compliance. Many people are prescribed medication when out on a AOT order to reduce potential liability and risk of harming behavior simply because they have reached this level of care in their local community mental health system. There is a percentage of people who can operate without incident and do their own self satisfaction without medication or certain lowered dosages but are kept on a regimen which is unreasonable because now a team of clinicians is held responsible for their care and safety. The bigger problem is people don’t have a choice about which medications to take, they are prescribed, and without court intervention, the person must comply or else they run the risk of being taken to the hospital involuntarily.
This bleeds into uses and misuses of 939/940 orders which, if signed by a doctor, can mean a person whom is believed to be at risk of immediate harm can be taken to the hospital from their home. I have had the sobering experience of carrying out these orders. I have witnessed police break down doors, hand cuff patients, and drag them out of their homes by force to the hospital. As a peer and therapist, I can tell you this is extremely traumatic. There has to be a better way than this to carry out treatment albeit mandated. Sadly, it gets even more extreme than the the 958 order. The notorious Out Patient Pickup order carries with it the lawful police search and arrest of patients in the community at their place of work or wherever. Now, imagine, your angry and missed a few appointments with your doctor. You have an AOT order. Your treatment team decides your too dangerous to yourself or others because you missed a few appointments and are a risk so you are dragged out of a Mc Donald’s in front of your friends and family and taken to the hospital by force. It happens; more often then you think, that clinicians make decisions based on liability then a persons actual mental status to cover themselves.
Is this the best system we can devise to keep people in treatment to reduce the likelihood of risk of immediate harm? Maybe.
Perhaps then the systematic intervention should be on how the orders are carried out and not on the existence of the laws itself which seem important on their face given community violence and loss of life.
The law is explicit and implicit in its explanation. It is complex and should be used as a guide to unpack this philosophical critique. Further posts will evaluate other aspects of the law and on the ethics of extending AOT orders and their initial execution and evaluation to be necessary for the community and individual assigned.