• Filed for the 2023/2024 legislative session by State Senator Cindy Friedman (D-Arlington) and State Representative Mathew Muratore (R-Plymouth) S.980 and H.1694 represent a true bipartisan approach.

• Currently under review by the Joint Committee on the Judiciary, which is chaired by Senator James Eldridge and State Representative Michael Day.​​

• No hearing date has been set as of April 18, 2023

AOTNOW has continued to work tirelessly to revise and optimize the proposal to bring AOT to Massachusetts. A key aspect of this work includes listening to the concerns of all concerned parties, whether they support or oppose AOT.

​​

• The new proposal further narrows the application of AOT in Massachusetts to apply only to those individuals suffering from with severe mental illness (SMI) who have demonstrated their need for it through recent difficulties adhering to prescribed treatment. In addition, due process rights have been clearly defined within the new draft.

• Additionally, S.980/H.1694 creates a new definition within the law for “Gravely disabled”, a condition evidenced by behavior in which a person, as a result of a mental illness, is at substantial risk of inflicting serious harm to self or others, or is in danger of serious physical harm resulting from a failure to provide for his or her essential human needs of health or safety; or manifests severe deterioration in routine functioning evidenced by repeated and escalating loss of cognitive or volitional control over his or her actions; and has shown an inability to provide for his or her basic physical needs, including medical and psychiatric treatment and shelter, because of the mental illness.

• An individual authorized to seek an AOT order for another initiates the process by filing a petition with the court, alleging that the other individual meets the legal criteria. The court schedules a hearing. If the petitioner An AOT administered through the courts establishes at the hearing that the criteria are met, with an order entering an individual into an AOT program issued by a judge following a judicial process the court may issue an AOT order and maintain oversight of the case for the order period.

• S.980/H.1694 include the following provisions: 

• Any physician licensed pursuant to section 2 of chapter 112, the department of mental health, the superintendent of a medical facility or residence where the individual receives medical care, or the medical director of the Bridgewater state hospital, or the spouse, blood relative, legal relative, legal guardian or individual partner in a substantive dating relationship, shall be authorized to petition for an order of a critical community health service treatment plan in the district court in whose jurisdiction a facility is located that shall provide such services, for any individual who:

• (1) has a primary diagnosis of a serious mental illness; 

• (2) is at least 18 years old; and 

• (3) meets the following criteria:

• (i) is gravely disabled;

• (ii) has a history of lack of compliance with treatment for mental illness that, prior to the filing of the petition, has been a significant factor in: (A) necessitating, at least twice within the previous 36 months, hospitalization or receipt of mental health services in a forensic or department of correction facility or house of corrections or the Bridgewater state hospital; or (B) the commission of one or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the previous 36 months;

• (iii) is in need of, based on the individual’s treatment history and current behavior, critical community health services in order to prevent a relapse or deterioration that would likely result in serious harm to the individual or others; and 

• (iv) is likely to benefit from critical community health services.

• The district court may grant a petition for assisted outpatient treatment upon finding by clear and convincing evidence that the respondent:​

  • (1) has a primary diagnosis of a serious mental illness; 

  • (2) is at least 18 years old; and 

  • (3) meets the following criteria:

  • (i) is gravely disabled;

  • (ii) has a history of lack of compliance with treatment for mental illness that, prior to the filing of the petition, has been a significant factor in: (A) necessitating, at least twice within the previous 36 months, hospitalization or receipt of mental health services in a forensic or department of correction facility or house of corrections or the Bridgewater state hospital; or (B) the commission of one or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the previous 36 months;

  • (iii) is in need of, based on the individual’s treatment history and current behavior, critical community health services in order to prevent a relapse or deterioration that would likely result in serious harm to the individual or others; and 

  • (iv) is likely to benefit from critical community health services.

A petition for AOT may be filed by the following:

​

• A physician, after examining the respondent

• Department of Mental Health

• An adult family members

• An adults residing with the respondent

• The superintendent of any public or private facility or hospital authorized for the commitment or treatment of mentally ill persons

An AOT order cannot last longer than 1 year. However, if at the end of the order period a clinical evaluation finds that the individual remains unwilling or unlikely to adhere to treatment on a voluntary basis, an authorized petitioner may seek renewal of the order for an additional period. The court may only grant the renewal if it finds by clear and convincing evidence that the individual continues to meet the legal criteria.

• If the supervising mental health professional informs the court that the individual is not in compliance with the court-ordered treatment plan, the court may potentially commit the individual to inpatient (hospital) care. However, this action requires a finding by the court that the individual has come to meet Massachusetts’ usual inpatient commitment criteria (“likelihood of serious harm”). As in any circumstance, such a court finding must rely on a fresh clinical evaluation. If the court is unable to make this determination from the information available (typically, because the individual is in the community and unwilling to submit to a clinical evaluation), the supervising mental health professional may petition the court under existing law for a three-day commitment of the individual to accomplish the evaluation.

​

• The court is not permitted to hold an individual in contempt of court for failure to adhere to treatment. Thus, non-compliance cannot lead to the person being placed in jail or punished in any manner.

​

• If the individual’s non-adherence takes the form of a failure to take prescribed medication, the court is not permitted to order that the medication be forcibly administered.  As under current law, involuntary administration of medication may take place only while an individual is under hospital care.

• Yes, this proposal provides the proper balance between individual rights of individuals suffering from with severe mentally illness and the responsibility of family, friends, and caregivers to seek court intervention in extreme circumstances assist those trapped in the “revolving door” due to their inability to recognize their own need for care.

​

• This proposal not only establishes a very narrow criteria for whom AOT would apply, but also and creates well defined system of provides ample due process under which AOT can be utilized as a treatment tool before AOT may be ordered by the court.