First Steps to Community AOT

 Starting an AOT program entails a complete paradigm-shift for everyone in the system. It shifts us from being strictly reactive (waiting for danger) to being proactive in preventing trouble. Because so many people are involved, the first step is to get all stakeholders in agreement. This may sound easy…..but it’s far from simple. There are people who oppose AOT strongly, and any new expenditure is going to draw tight scrutiny at first. Everyone needs to air their concerns and objections, finding ways to address and meet them.

Who are the stakeholders?

The stakeholders are everyone in the community who will be involved in a professional role. An AOT program would change how they handle part of their jobs, and only they can understand what that will mean. Treatment Advocacy Center, a non-profit organization that has been centrally involved in helping many states set up programs, advises:

“At a minimum, these leaders include:

  • Public mental health authority administrator

  • Civil court judge or magistrate

  • Mental health professionals representing community-based, inpatient and psychiatric crisis services

  • District Attorney/Prosecutor

  • Public Defender

  • Sheriff and/or Police Chief

  • Mental health advocacy organization director

Our county’s Department of Human Services started discussing the possibility of developing Assisted Outpatient Treatment after the pandemic-related problems began to go away. They are doing very early exploratory experimenting to see what it would take to set it up.

I’m going to be trying, during 2024, to reach out to various stakeholders that I haven’t heard from yet, to see how they feel. I know that some of them have been thinking seriously about it already, and probably all of them have at least considered or read about the issues.

Allegheny County: Where are we now?

We can’t ever get a community to buy into a plan unless we address honest objections. I have heard three main objections to AOT. I’ll address each one briefly:

  1. “I’m afraid that it can be used to take away personal freedoms. A vindictive family (or ex-family) member or an oppressive government might force us to be on medications that keep us sedated.” Answer: If someone filed an AOT petition without solid evidence that represents the viewpoints of many observers, if that “AOT petition” was just their opinion and made accusations, it would fail when it came before a judge. Being under an AOT order is also not a sentence to be on sedating medications, since each AOT participant has a team to work with. The goal is to find the least restrictive medication plan that allows someone to live safely in the community.

  2. “I’m traumatized from being put in a psychiatric hospital and I don’t think we should force anyone to accept medication involuntarily.” Answer: the point of AOT is to keep you out of the hospital. But only in an ideal world would we never need to require involuntary medication — only in a world in which all brains work well and all decisions are rational. We don’t need to medicate people who are just odd or have unusual lives. AOT is directed at solving the problem of genuine disability.

  3. “It sounds like it costs a lot.” Answer: Yes, but right now every county is already bearing the cost of untreated brain-behavioral illness. This cost is broken up among the jails, the hospitals, and families who bear a crushing burden of trying to keep a son, daughter, husband, wife, mother or father safe and their families intact. Untreated illness sends people in and out of jails and hospitals frequently, and it makes their families lose work time and live in fear. When the cost of AOT is paid up front, the cost of jail and hospital care goes down. Hardest of all to count is the cost to families, who may suffer property damage and other harm.

Who would object to AOT?

What can you do?

I’m just starting to advocate for AOT in Allegheny County. You can start by joining me in sending me your email contact. I hope to organize some public information meetings, and I’ll post that here as well as creating a mailing list with your emails. If you are part of one of the Stakeholder offices, I’d love to hear from you.