Wednesday, January 23, 2008

AOT patients benefit from agency collaboration

In Summit County, Ohio thousands of seriously mentally ill people have benefited from court ordered outpatient treatment. The effectiveness of assisted outpatient treatment (AOT) in decreasing hospital admissions in Summit County was clearly established over a decade ago, when they documented a decrease from 1.5 to 0.4 per year before and after AOT (Munetz et al. 1996). AOT also increased patients’ compliance with outpatient psychiatric appointments from 5.7 to 13.0 per year and with attendance at day treatment sessions from 23 to 60 per year (Munetz et al. 1996).

I recently joined a team of Treatment Advocacy Center representatives who traveled to Akron, Ohio to learn more about this highly successful program. During our two day visit, we interviewed representatives from many different agencies and heard from people who depend upon services from Summit County for treatment of their mental illnesses.

Over 15 years ago, mental health officials in Summit County established a new framework for continuing court supervision of mentally ill people once they were released from inpatient care. While well designed on paper, the ultimate success of this program comes from the way that all of the participating agencies work together to uphold the program’s purpose. Assisted Outpatient Treatment thrives in Summit County because judges, lawyers, mental health professionals, caseworkers, and law enforcement officers all recognize the benefits of AOT as a legal mechanism and also share the same strong desire to see seriously mentally ill people stay well.

The outpatient commitment process in Summit County begins with the release of a person from inpatient care. The judges of the Summit County probate court reasonably interpret Ohio’s commitment laws as allowing outpatient care for patients who are released from hospitalization but who still need court ordered treatment to avoid rapid deterioration. Taking into account all relevant circumstances, the courts carefully balance the patient’s need for continued supervised treatment against their ultimate right to return to the community without restrictions.

In turn, county case workers who assist these seriously ill patients in the community readily acknowledge that this continuation of court ordered treatment greatly increases treatment compliance and decreases practical problems for patients. The understanding that he or she is subject to an ongoing court order and may be ordered back for further evaluation is a sufficient inducement for most patients to comply with their treatment plans.

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