Continuum of Care for severe mental illness (known in some states as Assisted Outpatient Treatment or AOT) is the practice of civil court ordered and supervised community-based, person-centered mental health treatment that is a less restrictive alternative to a civil commitment for inpatient treatment. The program is designed to encourage those suffering from severe mental illness (SMI), who struggle with voluntary treatment adherence, to engage fully with their treatment plan, as well as to better coordinate with treatment providers to keep the individual engaged in the treatment plan.

 

AOT laws allow continued treatment of people with SMI in the community, so that they can live a healthy, safe and productive life. Currently, 48 states have AOT laws. MA is one of only 2 states which does not have AOT laws.

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The essential elements of an AOT program are to (Courtesy of the Treatment Advocacy Center):

1. identify individuals within the service area who appear to be persistently non-adherent with needed treatment for their mental illness and meet criteria for AOT under state law;

2. ensure that whenever such individuals are identified, the mental health system itself takes the initiative to gather the required evidence and petition the court for AOT, rather than rely on community members to do so (although community members should not be impeded from initiating an AOT petition or investigation where permitted by state law);

3. safeguard the due process rights of participants at all stages of AOT proceedings;

4. maintain clear lines of communication between the court and the treatment team, such that the court receives the clinical information it needs to exercise its authority appropriately and the treatment team is able to leverage the court’s powers as needed;

5. provide evidence-based treatment services focused on engagement and helping the participant maintain stability and safety in the community;

6. continually evaluate the appropriateness of the participant’s treatment plan throughout the AOT period, and make adjustments as warranted;

7. employ specific protocols to respond in the event that an AOT participant falters in maintaining treatment engagement;

8. evaluate each AOT participant at the end of the commitment period to determine whether it is appropriate to seek renewal of the commitment or allow the participant to transition to voluntary care;

9. ensure that upon transitioning out of the program, each participant remains connected to the treatment services they continue to need to maintain stability and safety.