Testimony in Support of H. 1933 An Act Establishing Assisted Outpatient Treatment

Type:  Testimony 


Chairwoman Flanagan, Chairwoman Malia, and members of the Committee, I would like to thank you for the opportunity to testify before the Committee today. I am here to testify in support of H. 1933, An Act Establishing Assisted Outpatient Treatment
Approximately 6 million Americans today suffer from a severe mental disorder such as schizophrenia or manic depressive disorder. Forty percent of all individuals with a severe mental illness are not receiving treatment at any given time. Assisted outpatient treatment (AOT) is court-ordered treatment for individuals with a history of medication noncompliance. In order to remain in the community, the individual must undergo certain treatments for their mental illnesses. Typically, violation of the court-ordered conditions can result in the individual being hospitalized for further treatment. Forty-two states permit the use of assisted outpatient treatment, also called outpatient commitment.
This legislation would allow providers to protect mentally ill persons whose ability to make informed decisions about their care, such as controlling dangerous behavior, taking medication, and keeping regular appointments have been impaired by their illness. In addition, this bill would allow the superintendent of any public or private facility or hospital authorized for the commitment or treatment of mentally ill persons, any physicians, psychiatrists, licensed psychologists, licensed social workers, or psychiatric nurse clinical specialists to petition the district court for outpatient commitment for any patient that they determine mentally and displays one or more of the specified criteria as mentioned in the bill.
Any petition would include a written outpatient treatment plan prepared by those familiar with the patient’s case history and approved by the superintendent or physician in charge of the patient’s care. Prior to the commitment to outpatient treatment, the patient would be provided copies of the court order and full explanations of the approved treatment plan. More importantly, the patient’s treatment plan would be reviewed every thirty days.
Lastly, the outpatient commitment, as specified in the bill, would be converted to an inpatient commitment if the patient is non-compliant to the terms of the treatment plan and the court orders placement into an inpatient treatment program. Also, the medical director would have the ability to petition the court at anytime to terminate the outpatient commitment if the outpatient treatment is no appropriate. Any person would also have the ability to petition the court to terminate the patient from the outpatient commitment.
H. 1933 provides several benefits. First AOT reduces hospitalizations. In North Carolina, AOT reduced hospital admissions by 57 percent and the length of stay by 20 days. For individuals with schizophrenia and other psychotic disorders, AOT reduced their hospital admissions by 72 percent and length of stay by 28 days as compared to individuals without court-ordered treatment. New York State reported that over the course of 5 years, individuals who were receiving assisted outpatient treatment were 77% less likely to be hospitalized than in the past.
Second, AOT reduces homelessness. National date estimates that approximately 200,000 individuals with schizophrenia or manic depressive disorder are homeless, comprising one-third of the estimated chronically homeless.   At any given time, more people live with untreated severe psychiatric illnesses on America’s streets than receive care in hospitals.
Third, AOT reduces arrests. Arrests in New York from Kendra’s Law, their version of AOT, participants plummeted from 30 percent prior to the onset of a court order to only 5 percent after participating in the program. Compared to a similar population of mental health service recipients, participants in the program were 50 percent more likely to have had contact with the criminal justice system prior to their court order.
Fourth, AOT reduces violence. Long term AOT combined with routine outpatient services can be significantly more effective in reducing violence and improving outcomes for severely mentally ill individuals than routine outpatients care without assisted treatment. North Carolina, New York, Arizona and Iowa have outpatient commitment programs with significantly improved outcomes. Also, Kendra’s Law resulted in dramatic reductions in the incidence of harmful behaviors for AOT recipients at six months as compared to a similar period of time prior to the court order. Among individuals participating in AOT: 55 percent fewer recipients engaged in suicide attempts or physical harm to self; 47 percent fewer physically harmed others; 46 percent fewer damaged or destroyed property; and 43 percent fewer threatened physical harm to others. Overall, the average decrease in harmful behaviors was 44 percent.
Lastly, H. 1933 would improve substance abuse treatments. Individuals who received a court order under New York’s Kendra’s Law were 58 percent more likely to have a co-occurring substance abuse problem compared with a similar population of mental health service recipients. The incidence of substance abuse at six months in AOT as compared to a similar period of time prior to the court order decreased substantially: 49 percent fewer abused alcohol and 48 percent fewer abused drugs.

I strongly urge the Committee to adopt a favorable for H. 1933 as expeditiously as possible. Thank you for consideration on this important legislation.