Why AOT is necessary

We often hear the argument that if you just have enough voluntary services, the need for AOT will disappear. Of course that isn’t the case, as anyone who works with the most severely mentally ill will tell you. Some individuals simply cannot understand that they are sick and will never accept voluntary services. That is why AOT is necessary, no matter how comprehensive the voluntary system is.

One telling example is California’s AB 2034 program. AB 2034 is comprehensive statewide homeless outreach program, offering premium wrap-around-services with a special emphasis on housing. And it has achieved very good overall results for participants, including decreases in homelessness, incarceration and hospitalization. But the AB 2034 programs have a major limitation; they are voluntary in nature and cannot help those individuals whose illness causes them to refuse needed care.

In a 2003 report to the State Legislature regarding the program, the California Department of Mental Health reported that, “1958 consumers, 22.7% of all the consumers ever enrolled, have simply disappeared or dropped out in most cases, without explanation.” And this number fails to capture the individuals who refused to ever enroll in the program, despite the promise of housing and comprehensive services.