Hopeful Progress and What’s Next
In my last column I wrote about a Des Moines City Council proposal to start fining individuals caught sleeping outside in public spaces, and how this proposal would particularly affect our mentally ill citizens experiencing a condition called anosognosia. I’m happy to report the proposal was voted down a week later. Though Des Moines still isn’t adequately addressing the desperate need for affordable and transitional housing, at least the city stopped short of punishing its most vulnerable and ill citizens.
Another piece of good news: the West Des Moines-based Community Support Advocates disability and mental health service provider is launching an outpatient competency restoration program—a service Iowa currently doesn’t have—aimed at helping mentally ill defendants charged with nonviolent offenses become competent to stand trial. The goal is for the program to soon be fully operational and serving a dozen or more defendants at a time statewide. In a recent interview with the Des Moines Register, CSA reports they often see clients “stuck in jail for long periods, waiting for treatment in Iowa’s bottlenecked system to restore them to competency so they can face criminal charges. Now, the agency is preparing to offer those services itself.”
And finally, the University of Iowa College of Education is launching a new undergraduate counseling major this fall for students interested in studying behavior health counseling. As the mental health and healthcare crisis in our state intensified post-COVID and in the wake of provider shortages, more and more students are expressing interest in the counseling profession.
What’s Next?
In light of these three bits of positive news, the next big piece of the treatment puzzle mental healthcare advocates have long been clamoring for is a statewide Assisted Outpatient Treatment system.
According to the Treatment and Advocacy Center, assisted outpatient treatment (AOT) is the practice of providing community-based mental health treatment under civil court commitment, as a means of: (1) motivating an adult with mental illness who struggles with voluntary treatment adherence to engage fully with their treatment plan; and (2) focusing the attention of treatment providers on the need to work diligently to keep the person engaged in effective treatment.
AOT is a less restrictive alternative to involuntary inpatient treatment and may also be ordered if a patient has difficulty living safely in the community without close monitoring.
The essential elements of an AOT program:
· Identify individuals within the service area who appear to be persistently non-adherent with needed treatment for their mental illness and meet criteria for AOT under state law
· Ensure that whenever such individuals are identified, the mental health system itself takes the initiative to gather the required evidence and petition the court for AOT, rather than rely on community members to do so (although community members should not be impeded from initiating an AOT petition or investigation where permitted by state law)
· Safeguard the due process rights of participants at all stages of AOT proceedings
· Maintain clear lines of communication between the court and the treatment team, such that the court receives the clinical information it needs to exercise its authority appropriately and the treatment team is able to leverage the court’s powers as needed
· Provide evidence-based treatment services focused on engagement and helping the participant maintain stability and safety in the community
· Continually evaluate the appropriateness of the participant’s treatment plan throughout the AOT period, and make adjustments as warranted
· Employ specific protocols to respond in the event that an AOT participant falters in maintaining treatment engagement
· Evaluate each AOT participant at the end of the commitment period to determine whether it is appropriate to seek renewal of the commitment or allow the participant to transition to voluntary care
· Ensure that upon transitioning out of the program, each participant remains connected to the treatment services they continue to need to maintain stability and safety
While the new CSA outpatient competency restoration program is a positive step forward, we need to turn our focus to building a system that helps prevent patients from ending up in jail in the first place, and AOT programs are designed to do exactly that.
Where to Find AOT?
Currently, forty-four states permit the use of assisted outpatient treatment (AOT). The six states that do not have assisted outpatient treatment statutes are Connecticut, Maryland, Massachusetts, New Mexico, Nevada and Tennessee.
In Iowa? There’s only one AOT program, in Johnston County. (Hat tip to Iowa City-area advocates who fought for it.)
Polk County, the most populous county in the state, has zero.
Two decades worth of extensive and diverse research has been conducted on the effectiveness of AOT in improving treatment outcomes for mentally ill individuals. The research demonstrated that AOT reduces the risks of hospitalizations, arrests, incarcerations, crimes, victimization, and violence. Furthermore, research showed that AOT also increases treatment adherence and eases the strain placed on family members or other primary caregivers.
In previous columns, I’ve mentioned my close family member who suffers from a complex serious mental illness and his struggles with chronic homelessness. He’s currently back in jail for yet another misdemeanor charge and will likely be there for some time. He would be an ideal candidate for the outpatient competency restoration program once it’s up and running, but more importantly, I know an AOT program likely would’ve help prevent him from landing in jail again in the first place.
To learn more about Assisted Outpatient Programs and implementing one in your community, visit the Treatment and Advocacy Center’s website. ~
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