Friday, September 14, 2012

AOT Myths: Debunked

AOT Myths: Debunked

There is a lot of misinformation about assisted outpatient treatment.
Here is a quick look at some of the myths and realities involved.

MYTH: Assisted Outpatient Treatment is going to fill hospital wards.
REALITY: Assisted Outpatient Treatment is designed to help people succeed out of the hospital. It helps those with a history of non-compliance induced dangerousness comply with treatment and therefore prevents them from deteriorating to the point where they need hospitalization.

MYTH: Assisted Treatment will empty hospital wards.
REALITY: Inpatient hospitalization will still be needed for those incapable of surviving safely in the community. Assisted outpatient treatment facilitates early short-term rehospitalization for those noncompliant and likely to become dangerous.

MYTH: Assisted outpatient treatment does not work.
REALITY: Studies in Iowa, North Carolina, Hawaii, Arizona and other states have definitively proven assisted outpatient treatment works.

MYTH: Assisted Outpatient Treatment will bust the budget.
REALITY: Assisted Treatment is not expensive because it does not mandate any services that individuals with brain disorders are not already entitled to (example: case management, medications, rehabilitation). Assisted Outpatient Treatment Orders merely require the system to facilitate compliance for non-compliant individuals by giving them the services they need to keep well and the surrounding community safe.

MYTH: Assisted outpatient treatment is unconstitutional.
REALITY: Forty-one states and the District of Columbia have assisted outpatient treatment laws. The Supreme Court has overturned none of these laws.

MYTH: Assisted treatment infringes on civil liberties.
REALITY: It is the illness, not the treatment that restricts civil liberties. Medicines can free individuals from the “Bastille of their psychosis” and enable them to engage in a meaningful exercise of their civil liberties. Assisted outpatient treatment cuts the need for incarceration, restraints, and involuntary inpatient commitment, allowing individuals to retain more of their civil liberties.
For more information:

Anosognosia Fact Sheet

When a person cannot appreciate that they have a serious psychiatric illness, a tremendous challenge to family members and caregivers follows. About one-half of people living with schizophrenia, and a smaller percentage who live with bipolar disorder, have this clinical feature. Individuals with Alzheimer's disease and dementia also often have this feature. The medical term for not seeing what ails you is anosognosia, or more commonly known as a lack of insight. Having a lack of awareness raises the risks of treatment and service nonadherence. From the person's point of view, if they feel they are not ill why should they go to appointments, take medication or engage in therapy?

Why can't a person see what is so apparent to those around them? The best thinking indicates this is a core feature of the neurobiology of the conditions. Frontal lobes organize information and help to interpret experiences. In conditions like schizophrenia and Alzheimer's disease, frontal lobe difficulty is central to the neurological processes that underlie the disorders. Psychological denial is not the reason for the lack of insight in these illnesses.

There are situations where a person's lack of insight can, at times, create dangerous situations. This combination of no insight and dangerous acts often requires intervention. In more than 40 states, there are laws for Assisted Outpatient Treatment (AOT), also known as outpatient commitment. AOT status requires a person to engage in treatment and gives the state authority to bring the person to a treatment center if they do not. All states that have these laws have protections and a process for assessing whether this intervention is appropriate. In most states, doctors are required to submit an affidavit of the person's state and the reasons for the requested AOT status and a judge decides.

AOT: For a list of current state laws see

Violence Against Homeless Persons

By:David Christiansen

In the dark hours early on August 27, while sleeping behind a building near Winchester Road in Lexington, a 61-year-old homeless man was set on fire. He is currently in intensive care at UK hospital, but is expected to survive. So far the police have no suspects in this hate crime.

However, the incident is not considered a hate crime at all because current law does not include homelessness as a eligible category for such an offense. The National Coalition for the Homeless is seeking to change that. In their on-going effort to highlight this type of crime, they publish a bi-annual report detailing their research into hate crimes committed against homeless people. In their most recent edition, Hate Crimes against the Homeless: Violence Hidden in Plain View, they tabulated these crimes from across the country. Kentucky is barely noted in their statistics with just 3 incidences in the last twelve years (California had 225 and Florida 198). These statistics exclude any acts of violence committed by homeless individuals against each other and a crime is included only if the attack was primarily motivated because the victim was a homeless person. The scope of the problem is highlighted in the report as follows:

"Over the past twelve years (1999-2010), hundreds of homeless people have been attacked and killed. While this report provides alarming numbers, many attacks go undocumented. Homeless people are treated so poorly by society that their attacks are often forgotten or unreported. In 2010 alone, one hundred thirteen incidents resulted in twenty-four deaths. Since 1999, The National Coalition for the Homeless has recorded one thousand, one hundred eighty-four acts of violence that have resulted in three hundred twelve deaths".

Another section of the report seeking to understand factors associated with these hate crimes, states that:

"There is a documented relationship between increased police action and the increasing numbers of hate crimes/violent acts against homeless people. Many cities...... have enacted severe anti-camping, panhandling, anti-feeding, and other criminalization of homelessness laws. Many of these cities ..... are also cities where hate crimes against homeless individuals have frequently occurred. One possible explanation for this is the message that criminalizing homelessness sends to the general public: “Homeless people do not matter and are not worthy of living in our city.” This message is blatant in the attitudes many cities have toward homeless people and can be used as an internal justification for attacking someone who is homeless".

Homelessness in Lexington has been accorded increased attention recently with a number of city ordinances proposed to our City Council and now under review, including such items as a "nuisance" ordinance to give police more options to control unwanted street behavior and another proposed ordinance change that requires any group planning to open a daytime drop-in center for homeless persons to undergo greater public scrutiny before being allowed to proceed. In addition, the city's Board of Adjustment is moving forward with closing down the Community Inn, a shelter for homeless men and women operated under the auspices of Emmanuel Apostolic Church.

The Mayor has recently established a Commission on Homelessness to address these and other homeless issues in Lexington. Given concerns about increasing violence against homeless persons and public policies that seek to criminalize homelessness, it seems far better for our city to approach concerns regarding homelessness in a collaborative and compassionate way as an inclusive community and not slip into the ugly and hostile patterns to which some cities have succumbed. As we increasingly move toward objectifying homeless persons as "them" and not "us", we risk our sense of community.

"We are not enemies, but friends. We must not be enemies. Though passion may have strained it must not break our bonds of affection". It is time to better appreciate these words spoken by Kentucky's most famous native son, Abraham Lincoln. Our city will be far better served by allowing ourselves to listen to "the better angels of our nature", as Lincoln suggested, as we seek to understand and find solutions for homelessness. Demonizing our homeless neighbors as the enemy will only lead to more fear, hatred and violence.

David Christiansen, MSW
Executive Director
Central Kentucky Housing and Homeless Initiative

Read the edited version of David's Story here on the LHL.

Demonizing the homeless leads to fear and violence

Read more here:


Demonizing the homeless leads to fear and violence

Published: September 10, 2012 

Read more here:

Read more here:

Mental Health Diversity from Kentucky's Appalachians

 [A Peer Recovery Support Specialist (P-RSS) is an occupational title for a person who has progressed in their own recovery from alcohol or other drug abuse or mental disorder and is willing to self-identify as a peer and work to assist other individuals with chemical dependency or a mental disorder. Because of their lived experiences, such persons have expertise that professional training cannot replicate.]

Waltr Lane, has been described by some as a controversial Appalachian social commentator. His first person stories about resisting authority, moon shining, dynamiting fish and cockfighting have made him a person of interest across Kentucky. Waltr, (a hit and run survivor) is married, has a family and is a contract employee of The United Mine Workers of America.

Please read Waltr's story and poem and learn from his words. Additionally, consider how ‘supportive employment' and evidence best practices combined with an AOT law could help individuals stay out of jail and give them the incentive to stay in treatment, therefore assisting them to find the 'bridge to recovery'. GG Burns - KY Mental Health Advocate

Recoverized, But NOT Cured
By:Waltr Lane, who lives in Eastern Kentucky and is a Certified Peer Recovery Support Specialist.

When I was put in jail for loitering, people said that made me a certified public nuisance. It really didn’t annoy me, because I was happy in jail. I had more freedom there than in the State Mental Hospital. Besides, the coffee tasted better.

I have always had problems with being therapized. Years ago, I believed a live psychologist. Many times the psychologist said she threatened to kill the President of the United States and nothing happened (that is freedom of speech). I decided I wanted to threaten somebody more important than that. I started threatening the President of the University, because he was someone everyone knew.

Wham! Bam! There were carloads of cops and off to jail I went for loitering. The police had more sense than that lying psychologist. Threatening people is called terrorist threatening and a 'go directly to jail' offense. Yet police are discreet and use common sense. They didn’t want to publicize our stupidity. I was arrested for loitering and then shipped to the state mental hospital. The hospital social worker told me the judge sent word that I would be in jail or the hospital until I got out of the city. I have been run out of the city but I went to trial and plead guilty and apologized. The judge asked me how he could stop me from loitering. I said that I had nothing else to do.

And, bam, back to jail I went and then back to the state hospital, where I have spent several seasons off and on.

I finally escaped from a locked ward and hitchhiked home to the mountains. I went to the local Mountain Mental Health Center. Idleness is the enemy of good behavior. So the therapist helped me find a minimum wage job. I behave for the money. This paid more than the Pepsi a day I made working in the hospital. I have been therapized, psych rehabbed, recoverized -- but never cured. 

Recently, I imagined something again. It was recommended that I imagined to regale the staff at the mountain state hospital about how I enjoyed my stay. I thought I was to talk about every available male staff laying hands on me at once as a pacification technique. Because of the nature of the questions the schedule maker asked, I thought I was to give a first person account of some inherently private experiences. My wife, who heard the state man give me the date and time, shared my delusional ideation. But he never called back and said I misunderstood.

Apparently the hospital man had contacted a PhD person for the politically correct and official view of mental hospital life from an academic standpoint. I ain’t cured but I know better than to argue with the hospital man’s story.

I wonder why publishers print my writings and I get to speak nearly everywhere except I wasn’t going to speak in the next state where I was given a printed invitation and not interviewed. I still ain’t. I don’t like going where people recognize that a satirist is a dangerous person to mislead.

The Hillbilly Poet, Prison for Minds
By: Waltr Lane

The four staff
sat in a circle seance,
Keyboarding iPhones in a silent gaze,
Ignore the mental patients,
Who gave their raison d"etre.

A mental ward is another climate
where emotional winds
blow not from God's reason.

Forgive me, I pray, for saying
Sex is a necessity
Rape is not.

The psych ward staff pronounces,
Karen gives people an evil look;
Grabbing their momentary attention.
It is easy to ignore,
those who are social mutes.
The Hillbilly is the only witness
with a voice:
He cries, "help my people"
out of this prison
      without bars.