Ann Corcoran, RN, MSN

Enough is Enough: The Case for Assisted Outpatient Treatment

Any parent can attest that it is heartbreakingly difficult to watch your child suffer. This is particularly true when your child suffers from a chronic illness, such as a serious mental illness (SMI).

For us parents, our anguish is compounded by the fact that our adult children continue to be harmed by the failures of our mental healthcare system here in Massachusetts—a system we believe fails to help those most in need. Specifically, in adults suffering from SMI, a history of treatment avoidance too often leads to frequent involuntary hospitalizations or incarceration.

Often, these individuals also suffer from anosognosia, a condition that prevents them from acknowledging their mental illness and adhering to treatment.

In these extreme cases, families witness their loved ones stuck in an endless cycle of repeat hospitalizations, homelessness, joblessness, and despair. These conditions not only can seriously impair one’s quality of life but are often fraught with danger, leading to interactions with law enforcement and potential incarceration—or even worse outcomes including death by suicide or homicide.

Assisted Outpatient Treatment (AOT), also referred to as Community Based Healthcare Services, provides community-based behavioral health services under court order to people suffering with SMI who have demonstrated an inability to adhere to treatment and have difficulty living safely in the community without close monitoring.

A true AOT program is not voluntary – it provides person-centered, compassionate services for those who meet very specific criteria usually because of anosognosia. It provides involuntary treatment in the community rather than waiting until someone deteriorates to meet inpatient involuntary commitment standards.

By providing continuity of care under court supervision, these programs treat people suffering from SMI on an outpatient basis within their community. Also, an AOT order is limited to one year and can be extended if needed. For most patients, one year of continued care and supervision can provide the stabilization needed to live independently.

Unfortunately, Massachusetts is one of just three states without an AOT law on the books. Despite years of attempts to bring AOT to the Commonwealth, the initiative has been routinely blocked by patient rights advocates and defenders of the status quo system. This opposition appears to be rooted in a grave misunderstanding of what AOT is and what it is not.

To begin with the latter, AOT is not forced medication nor is it institutionalized care. The sole goal of AOT is to provide treatment and care in a community setting—not in a hospital or locked facility.

In addition to treatment, this type of community-based healthcare can also include housing and other services that are crucial in improving the overall quality of life for those suffering from SMI. This coordinated approach ensures continuity of care, which can break the endless cycle of our current failed mental health system.

We are also aware that some of those opposed to this approach do so out of the belief in individual freedom. They believe that court-supervised care is “coerced” care and, therefore, a violation of personal rights.

We believe strongly in personal rights. Our children have a right to live free of the debilitating effects of their SMI. They have a right to live freely in their community without being imprisoned by a treatable disease or disorder.

As a society, we are failing the most vulnerable among us. As parents, we have witnessed the failings of the system firsthand. Enough is enough! The system must change.

While there is no magic cure for SMI or a one-size-fits-all approach to treatment, AOT or community-based healthcare services are proven to be effective. Under court supervision, people suffering from the most acute cases of SMI can get the help they deserve.

Our loved ones deserve better than they have received from our failed mental health system. They need our help in speaking up and getting them the help that they truly deserve.

As parents, we refuse to sit idle and watch our children suffer within a failed system.

Ashoke Rampuria, MS
Co-Founder AOTNOW

Vinita Rampuria, MSW
Co-Founder AOTNOW

Ann Corcoran, RN, MSN