One of the provisions that is keeping a House mental health reform bill from relatively easy passage involves assisted outpatient treatment. Some experts say it has been unfairly labeled as questionable since widespread evidence has shown success.
A few organizations, however, and about 20 Democrats in the House Energy & Commerce Committee, say assisted outpatient treatment, or AOT, is not proven to be helpful and the law as currently written would punish the five states that don't have AOT laws on the books.
AOT is court-ordered outpatient treatment for people with severe mental illness and a history of not following treatment.
The bill's sponsor, Rep. Tim Murphy (R-Pa.), has said he will revise the wording to ensure that states are not required to have AOT, but are rewarded for it. The bill is scheduled for markup this week.
His office said the bill would give block grants to all states and an additional 2% bonus to states with AOT laws. A Congressional Research Service report found that the law could be interpreted in such a way that states without those laws would have funding restrictions.
A companion bill in the Senate does not include language regarding AOT. It is scheduled for markup sometime early next year.
John Snook, executive director of the Treatment Advocacy Center, said AOT treatment is necessary. Studies from the past several years show there are people who need more than voluntary treatment to remain in their communities.
The practice is supported by the U.S. Justice Department, Substance Abuse and Mental Health Services Administration, American Psychiatric Association and National Alliance on Mental Illness, he said.
“It's not a controversial program anymore,” he said, except on Capitol Hill.
Snook said he understands the concerns that the bill will spur belief that people who are mentally ill are also violent, but the program isn't for violent individuals. It is for people who are caught up in jail or are homeless.
It can help prevent the illnesses that cause everyday stigma, he said.
“What (people are) going to see is the guy on the street who's talking to himself,” he said.
A lack of providers to treat mental illness is a concern with AOT, but the House bill has measures to help increase the number of beds and other treatment options. Helping people who frequently cycle in and out of various mental health services can actually free up providers for others in need, Snook said.
Raymond Bridge, public policy director for the National Coalition for Mental Health Recovery, said the bill doesn't do enough to increase the number of providers, social workers and case managers available.
More finances should be directed toward housing, crisis prevention and community mental health services, he said.
"Let's learn how to really engage people on their own terms," he said.
The letter from some House Democrats says they support a state's right to have AOT but do not think funding should be used to incentivize it. They say people who are not a harm to themselves or others should not be forced into treatment and worry it will be disproportionately used on minority populations.
A study of New York's AOT law in 2009 by researchers with the Duke University Medical School found no racial bias.