AOT Orders a Useful Tool during COVID Pandemic

January 7, 2021 | Frank P. Izzo | Cassandra Rivais DiNova | Behavioral Health | Hospitals | Legislation and Public Policy

The pandemic has prompted the reallocation of hospital beds from psychiatric care to treatment of COVID patients. This has occurred as mental illness has been on the rise. To cope with the insufficient number of psychiatric beds, it is important for hospitals to curtail readmissions. An often-underutilized tool to do so is the assisted outpatient treatment (AOT) order.

An AOT order is a court order directing a patient to engage in certain therapy, treatment or medication regimens to be monitored by a municipal entity, typically the county mental health department. AOT orders help mental health patients comply with taking their medications, which in turn can minimize readmission.

According to AOT recipient outcome data from the NYS Office of Mental Health (OMH) as of January 4, 2021, AOTs reduce psychiatric hospitalization by 65%, incarceration by 73%, and homelessness by 62%. OMH’s data also shows that AOTs increase service participation, increase engagement in services and adherence to medication, improve self-care and social and community functioning, and reduce incidents of harmful behavior.

All states except for Connecticut, Massachusetts and Maryland allow for AOT orders. In New York, the process for obtaining an AOT order is set forth in Kendra’s Law, established in 1999. A court may not issue an AOT order unless it finds that the treatment is the least restrictive alternative available for the patient and appropriate under certain defined circumstances. As part of the process, the patient has the right to a hearing. If issued, the order may last up to one year.

The petitioner (usually a hospital, inpatient psychiatric treatment center or the county commissioner of mental health) must establish, through clear and convincing evidence, that the patient:

  1. is 18 years or older;
  2. is suffering from a mental illness;
  3. is unlikely to survive safely in the community without supervision, based upon a clinical determination;
  4. has historically failed to comply with mental health treatment that has included:
    • Prior hospitalizations: at least twice within the last 36 months the failure to comply has been a significant factor in necessitating hospitalization, or receipt of services in a forensic or other mental health unit of a correctional facility or a local correctional facility, not including any current period, or period ending within the last six months, during which the person was or is hospitalized or incarcerated; or
    • Prior serious violent behaviors: toward self or others or threats of, or attempts at, serious physical harm to self or others within the last 48 months, not including any current period, or period ending within the last six months, in which the person was or is hospitalized or incarcerated;
  5. is, as a result of the patient’s mental illness, unlikely to voluntarily participate in outpatient treatment that would enable him or her to live safely in the community;
  6. in view of his or her treatment history and current behavior, is in need of assisted outpatient treatment in order to prevent a relapse or deterioration, which would likely result in serious harm to the person or others; and
  7. is likely to benefit from assisted outpatient treatment.

As part of the petition, the petitioner must prepare and include a written treatment plan outlining the recommended therapeutic treatment and medications, and whether substance abuse rehabilitation is necessary.

Providers who are treating a patient who meets the above criteria are urged to consider utilizing Kendra’s Law to obtain an AOT order for the individual.

Given the positive results, AOTs have been shown to be an effective tool to combat repeat hospitalizations and incarcerations for many severely mentally ill individuals and a useful motivator for their safe reentry into the community.

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