Tuesday, July 30, 2013


THE EVIDENCE IS IN: For people who deny they have a serious mental illness, refuse treatment and cascade into out-of-control behavior that can be threatening to themselves or others, assisted outpatient treatment works. It also saves more money than the costs of hospitalization or jail. Policymakers who say it is too expensive no longer have an excuse not to provide this life-saving tool.



It just got a lot harder for opponents of court-ordered outpatient treatment for mental illness to argue that it costs too much to use.

A study of mandatory outpatient treatment costs published today in the American Journal of Psychiatry found that use of assisted outpatient treatment (AOT) can vastly reduce overall costs of mental health services for persons with serious mental illness.

 “Common sense has always argued that treating people with severe mental illness is a lot cheaper than hospitalizing people or leaving them to suffer other consequences of being untreated – not to mention more humane,” said Doris A. Fuller, executive director. “Now Duke University and its research partners have produced the numbers to validate it.”

“The cost of assisted outpatient treatment: Can it save states money?” by Dr. Jeffrey W. Swanson of Duke and six other researchers reports that service costs for 634 frequently hospitalized patients with severe mental illness declined 50% in New York City – from $104,753 to $52,386 – in the first year they received AOT after psychiatric hospitalization and dropped another 13% the second year.

Even larger cost savings were reported in five suburban New York counties also analyzed in the study.

Swanson and fellow researchers analyzed the costs of providing program, selected legal and court services and mental health and other medical treatment to people who met the strict criteria for New York’s involuntary outpatient treatment program (“Kendra’s Law”). Dramatic  savings were realized even though the cost of providing outpatient services to people under Kendra’s Law AOT orders was higher.

The researchers said that by saving money with greater use of AOT, mental health agencies could actually find themselves with more resources to meet other mental health needs.

“Unfortunately, compassion for those suffering these consequences as a result of untreated symptoms of severe mental illness has not been enough to motivate most communities to put their AOT laws to work,” Fuller said. “We hope the prospect of saving their taxpayers money will.”

Read our complete statement on the study.
Read the abstract for "The Cost of Assisted Outpatient Treatment: Can It Save States Money?".

Read coverage in the New York Times, "Program Compelling Outpatient Treatment for Mental Illness Is Working, Study Says."

 Treatment Advocacy Center
200 N. Glebe Road, Suite 730, Arlington, VA 22203
703 294 6001/6002 (phone) | 703 294 6010 (fax) |


  1. Also known as Assertive Community Treatment.. which has been proven modality since the 1970's for chronic and severe mentally ill patients, especially those suffering from Schizophrenia...

  2. Thanks for your reply Jeanie.

    Many years ago, ACT may have been confused with assisted outpatient treatment, AOT, but today-- there is a difference.

    AOT -- assisted outpatient treatment, is: court-ordered treatment (including medication) for individuals who have a history of medication noncompliance, as a condition of their remaining in the community. Studies and data from states using AOT prove that it is effective in reducing the incidence and duration of hospitalization, homelessness, arrests and incarcerations, victimization, and violent episodes.

    There are many, many links on this Blog that explains AOT in detail such as:

    Assertive Community Treatment or (ACT), (promoted by NAMI) is:
    an effective, evidence-based, outreach-oriented, service delivery model for people with severe and persistent mental illnesses. ACT is a self-contained program that provides treatment, rehabilitation and support services to consumers who have a history of multiple hospitalization treatments. ACT services include supported housing and co-occurring psychiatric and substance use disorder services.

    Although ACT teams are very much needed in order for an AOT order to be successful, for most individuals with SPMI, (especially those who lack insight and will not be able to help themselves or who are unable to follow a treatment plan independently) -- ACT along cannot help a person remain in treatment. It takes a court order for many and ACT teams cannot do that.

    I am speaking from very personal experience here in KY, that even the most caring and experienced social worker/case manager sometimes cannot talk an individual who is acutely psychotic into accepting medication, supports, housing, etc., -- without there being 'treatment first'. That is why states need better AOT laws, or policies written in a way they can be funded and utilized. That key point is why this blog was established.