Question 1

Why AOT?

Accepted Answer

More than 20 years of research has proven AOT to be an effective, humane, and just means of treating severe mental illness and helping these individuals to maintain independent lives.
 • AOT allows individuals to be court-ordered into outpatient treatment which is far less intrusive and costly than a hospital setting.
 • AOT requires a lower threshold criterion for court ordered treatment, which traditionally focused on the concern as to whether or not the individual was an immediate danger to themselves or others.
 • According to the Mental Illness Policy Org., “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%).”

Question 2

Does assisted outpatient treatment work?

Accepted Answer

Yes. Studies and experiences across the United States have documented or illustrated that assisted outpatient treatment works.
The Treatment Advocacy Center offers an AOT Learning Network  as a resource for to keep you engaged with your counterparts from across the Unites States and facilitate the sharing of great ideas and common concerns.

Question 3

How many people does this impact in Massachusetts?

Accepted Answer

179,311 – the number of people with serious mental illness
4,035 – the number of adults with serious mental illness incarcerated
608 –the total number of public psychiatric beds

Question 4

What is the difference between AOT and Roger’s Guardianship Laws in MA?

Accepted Answer

Assisted Outpatient Therapy (AOT) and court ordered treatment plan under Roger’s Guardianship in MA are mutually exclusive. While both AOT and Roger’s Guardianship can be court ordered for individuals suffering from severe mental illness, AOT is focused on outpatient treatment. Treatment administered under Roger’s Guardianship laws in Massachusetts is conducted in an inpatient hospital setting. The goal of the AOT is to engage the individual in treatment of their mental illness and to improve their wellbeing through outpatient care, rather than the more stringent options associated with inpatient hospitalization.

Question 5

Why an AOT law is needed in Massachusetts.

Accepted Answer

The current mental health law in Massachusetts is inadequate. The state is one of just three states that exclusively utilizes an outdated approach to addressing the needs of individuals suffering from severe mental illness. Currently, Rogers’ guardianship law is used in MA to treat patients with mental illness.

Question 6

Roger’s Guardianship law in MA

Accepted Answer

This law allows a guardian to be appointed with a court ordered treatment plan. However, this treatment plan can be implemented only in an in-patient hospital setting, if the patient refuses to take the medication. Under this law, patients are generally treated for few weeks in the hospital, and then discharged. There is no way to implement the court ordered treatment plan in the community, if the patient does not cooperate, which basically negates the purpose of a court ordered treatment plan.

Question 7

Why MA Health Care Law does not work

Accepted Answer

People with mental illness need to stay on their medication on a regular basis to live a safe and productive life. However, as part of their illness, they lack insight into their illness and the need to stay on medication. They routinely stop taking their medication, which leads to a prolonged decline, then hospitalization and treatment for a short period of time. They are generally released after few weeks of involuntary hospitalization and treatment. Since MA does not have AOT, there is no mechanism to keep them on treatment plan in the community. Patient generally stop taking their medication in the community, and then the cycle of hospitalization and treatment, after a prolonged decline, starts again.
Roger’s guardianship and court approved treatment plan is approved by a judge after thorough review of the case, which includes a public defendant appointed for the patient and both sides have opportunity to present their expert witness. The decree clearly states that the court finds that the incapacitated person’s judgement is compromised and the judge substitutes patient’s judgement with a court appointed treatment plan.
However, there is no way to implement this treatment plan in the community in MA. It is only applicable in a hospital.
Assisted Outpatient Treatment (AOT) fills this gap, so that the treatment can continue in the community.
AOT will eliminate an endless cycle of hospitalization and decline. It is also a known fact that continued treatment, without any lapse, improves effectiveness of treatment and outcome.
With advent of injectable antipsychotic medications, the treatment in most cases is required only once a month or every three months, which makes outpatient treatment easier to administer.

Question 8

Following are some the most commonly used statutes within the current MA Mental Health Law:

Accepted Answer

1. Section 12(a) – It allows health care worker or police to send a mental health patient, who is deemed harmful to himself/herself or others, to the hospital for evaluation, against his/her wishes.
2. Section 12(b) – It allows involuntary hospitalization for 3 days by a psychiatrist at a private or public hospital, if after evaluation, they feel inpatient treatment is needed.
3. Section 7/8 – Involuntary Admission for up to six months
4. Roger’s Guardianship - The Probate and Family Court has been charged with acting upon requests for permission to administer antipsychotic medication to individuals who are unable to consent to treatment themselves. A substituted judgment standard applies and, at a minimum, yearly reviews are required.

A Rogers guardianship is a type of guardianship where the court determines the guardian will be given authority to agree to extraordinary treatment for the incapacitated person. This usually refers to treatment with antipsychotic medication, but it may include other intrusive treatments and procedures.