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Assisted Outpatient Treament (AOT)

In this post I plan to discuss the reasons why involuntary medication compliance is needed in the community and safe for the mentally ill patient.

Forty-two states have what is called "Assisted Outpatient Treatment (AOT)," or "outpatient commitment" which is Court-ordered medication compliance (http://www.psychlaws.org/BriefingPapers/BP4.htm).

"What is a Petition for Assisted Outpatient Treatment: A mentally ill individual who does not comply with his/her treatment plan can deteriorate, lose the ability to make rational decisions, and become dangerous in the future. After a petition is filed, a hearing is set where a Judge would be able to order an individual into treatment Assisted Outpatient Treatment - if he/she demonstrates noncompliance" (http://www.oakgov.com/probate/faq/assist-outpatient-trtmt.html).

'Assisted Outpatient Treatment (AOT) has been known to reduce hospitalizations, arrests and incarceration, homelessness, violent episodes, and victimization' (http://www.psychlaws.org/BriefingPapers/BP4.htm). As a result of Kendra's Law "New York has seen drops of 77 percent in hospitalization, 85 percent in homelessness, 83 percent in arrests and 85 percent in incarcerations among people placed on involuntary outpatient treatment for the last six months of 2002" (http://www.psychlaws.org/GeneralResources/article128.htm).

Schizophrenia has the potential to affect everyone. Because someone with schizophrenia could commit a crime while in a psychotic state of mind. Committing a crime could cause someone else harm. In 1999 a person with schizophrenia pushed a women infront of a moving subway in Manhattan, this incdent led to legislation called Kendra's Law which support AOT (http://www.psychlaws.org/GeneralResources/article128.htm). Another example is my case while I was psychotic I stole the military truck to escape the "demons" and was evading the police when I hit another car. The other person was not seriously hurt, however, this could have been a fatal accident.

Not taking medication could lead someone to harm themself. They may be hearing voices that tell them to hurt themself. They could be suicidal.

Without medication the person could go down hill physically and mentally. For example, while I was experiencing psychosis I did not shower, eat, or speak to anyone. I did not trust anybody. In fact, I thought the cafeteria staff poisoned my food. I thought everybody was against me. I was not helping myself, I fell apart. Consequently, my family encouraged my attorney to let the Judge mandate that I take medication in the state of California.

The criteria for people with a mental illness to be Court ordered to take their medication is as follows (http://www.psychlaws.org/GeneralResources/article128.htm):
  • The person must be 18 or older, mentally ill and unlikely to survive safely in the community without supervision.
  • The person's failure to comply with treatment has been a significant factor in an admission for examination or treatment at least twice in the previous 36 months, or has resulted in at least one violent act, or threat or attempt to harm himself or herself or others in the past 48 months.
  • The person is, as a result of mental illness, unlikely to follow a treatment plan.
  • The person needs involuntary outpatient treatment to prevent a relapse or deterioration that could result in harm to the patient or others.
  • It is likely that the patient will benefit from involuntary outpatient treatment, and less restrictive alternatives are unsuitable.

Finally, I agree with the Court order to involuntarily medicate the mentally ill patient because they are a potential threat to themselves and the community. In my personal experience with my family encouraging the Judge to mandate medication compliance I am thankful because the medicine helps me think clearly and feel in control again. I think that had I been on medication prior to the incident, there would not have been an incident. Assisted Outpatient Treatment helps the individual by reducing their risk of being involved in a crime, homelessness, and harm to oneself and the community.

Is mandating someone by law to take their medication an infringement on their rights or is it helping them and the community?

Comments

I believe that under certain criteria it's best for the patient and others that they must be forced to take medication.
HektikLyfe said…
This can be very tricky. Of course they specify exactly what and what dosage of medication right? I can see this going really wrong if it isn't regulated. Some wacko politician using this to "clean up the streets" and actually just incarcerate and medicate every homeless person out there.
Valash said…
Anonymous Drifter,
I think that they should force medicate the individual if they have a history of doing crime. I also think that only the family and health care professionals should have the power to Petition the Judge to force medicate, not anybody off the street to bring about justice to the mentally ill patient.

Hektiklyfe,
Professional health care providers administer the medication. I don't think the Judge goes into details about which type of medicine and the dosage, they probably leave that to the recommendation of the professional health care provider. Different types of medicine and doses help different people, not everybody will react to the same medication dosage.
Valash~For years I didn't take meds. My illness spiraled wildly out of control, resulting in a decade of long-term hospital stays, ECT, loss of ability to work and more.

Had it not been for the fantastic support by my friends, I'd not be here today. I also know that they begged me not to agree to ECT, but I was too sick to listen. I lost three years of memory.

I can see the value of family and doctors getting courts involved. It would be great if the person had some one with Medical Power of Attorney, as I do. Some one that legally represent their wishes when it comes to treatment.
Karen D. said…
I am Ashley's therapist and have had the pleasure of getting to know this amazing young woman. Unfortunately she is in the minority of the people I have worked with who are diagnosed with Schizophrenia in that she understands her illness and takes her medications. She is intelligent and determined to do those things she wants in her life...
I am a firm believer in involuntary medication. I worked for 5 1/2 years in a state prison and we were able to force medicate people much easier than in the community. There is certainly the potential for misuse but in my opinion the benefits greatly outweigh the drawbacks. There needs to be a strong oversight in the process but it can help alot of people. Currently I work in a community mental health center and see people come in day after day who take meds only when they are in jail or the hospital. Once they feel better they stop. That is almost an inherent part of this illness. It is hard to see these people who you know would do better if they would just take their medications. But when symptoms in Schizophrenia are active judgement is poor and they cannot make decisions. Many people have improved when we 'forced' them to take medications. Then they continued on their own. We seem to be afraid of taking away people's rights to refuse meds but when they are dangerous or unable to care for themselves (criteria for 1013) i believe we have a responsibity to step in and help if possible.

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