Above is the case FOR Outpatient Commitment, also known as Assisted Outpatient Treatment. Some folks who have been subjected to / received AOT agree with this approach AFTER they have completed it...however...its this "retrospective endorsement" enough to warrant coerced medication and ECT administration? Is AOT just recreating asylum in the community? Answer these questions, and respond to one of your classmates' replies.
ReplyDeleteAfter doing my research about AOT Assisted Outpatient Treatment, I have mixed emotions. The law was passed after a young man who had mental illness pushed a girl onto the tracks of a subway in New York City. In the law, it gives the court system the power to have an individual revive treatment for their mental illness. Initially, I believe the law was put into place so the mentally ill could be locked away and not hurt other individuals. As time goes on, I believe the AOT programs have gotten more humane. I watched two videos were patients shared about being hesitant and upset; they were forced into treatment. After AOT programs, they were happy with the court's decision to have them receive help. Unfortunately, not all AOT programs have adjusted with the times, and many are still drugging the clients or using ECT. AOT programs that are not treating their patients humanely need to be revamped, so their patients are receiving the best treatment. All individuals deserve to be treated with respect and dignity when a person is being drugged instead of given valuable tools to help with their mental illness. AOT programs have the potential to be great places for people. Hopefully, AOT programs will become fixed before it is too late and they turn into modern asylums.
Victoria, I was also left with mixed emotions about this topic. It does appear that some AOT programs are doing their best to improve their clients' lives by offering support and medication that help them regain their lives as positively-contributing members of society. Others, however, do resemble community-based asylums. I agree with you completely when you state that AOT programs have the potential to be great. If they are run with the right intentions, humanely, ethically, and with compassion, I feel that they could be beneficial. However, if they medicate people just for compliance or provide dangerous treatments, I simply cannot support this style of "support."
Delete(Kaitlynn Littlefield)
Kaitlynn, I could not agree with you more. My hope for the future is more AOT programs can be run humanely and offer supports for the clients!
DeleteI have to say that, this form of treatment to me makes some sense. At some point and in some fashion clients are approaching the system looking for support and help, and I think that hospitalization is not the only answer. "It takes a village," Right? with that sentimentI think it is important to realize that people living in their communities and being supported have a better chance of success, they are not changing environments or going about life with a different routine or structure. The coercion piece I struggle with, I think a lot of the services and supports that are provided out there just need to be marketed a little better so the voluntary nature of someone's success and recovery are really coming from them and that they are in the driver's seat.
ReplyDeleteSean K
Sean,
DeleteI think you mentioned one really good benefit of AOT over the hospitalization route, the fact that the patient still remains connected to their community supports and day to day life routines. Similar to many rehabilitation processes it seems that the closer the client or patient is to their natural setting the better the process will go. The only way that I could see this not being as beneficial is if the clients natural setting and routine is the large contributing factor in their situation that lead them to the trouble or negative situation they find themselves in. Sometimes falling back into the "same old" groups of people or settings may not help the rehab process at all. I personally see this with some of my old high school friends that are dealing with substance use and other mental illnesses. I do however totally agree that more times than not the more natural the treatment is the better it will work. Like you also mentioned it comes down to marketing at some point as well.
- Spencer
Sean, You made some excellent points. I also believe that AOT is better than hospitalization. As you said, maybe more AOT programs need to be marketed differently, so the public has a better understanding and outlook about their facilities. I think when others are struggling with an addiction or mental illness, it is essential to have peer support, which is something AOT provides. If clients were provided with more information on what residential is, they might be more willing to get help.
ReplyDeleteLike those in the class who posted above, I too have mixed emotions and thoughts about this style of treatment. If a client is violently, has been in prison multiple times, or continuously threatens the safety of others, then I believe that AOT programs could be a great benefit to the individual. Prison systems are intended to be a place to become rehabilitated. Unfortunately, adequate mental health care is simply not often part of the equation in those settings because of overcrowding and a lack of resources. If a person is unhealthy and putting others in actual danger, then they must be respectfully and humanely helped. If a person refuses services but are still a danger to others, I do believe that we must help them. But, how far does that go? Is it right to force someone to take medication or comply with a treatment that they do not want? In most cases, no, I do not believe so. But if a person has shown violence before and has taken no steps to stop their aggression, then I do think it is, unfortunately, necessary.
ReplyDeleteWhat I have concerns with, though, is how this seems to only be half of the noted benefit according to the Treatment Advocacy Center. The other half is clearly financial in nature. It touts that the program has offered large cost savings around the country and that it has increased medication compliance. I wish that we could view recovery as a human need, rather than a financial burden. I understand that the cost associated with hospitalizations and jail stays are very real and a big concern, but it also can make the individuals who are involved sound less human and simply a burden to society. If we can eliminate the stigma associated with recovery and all it entails, I believe that society would be so much better off in the long run.
(Kaitlynn Littlefield)
There is no place to put the applause or hands up emoji here if there was I would have done so. Thank you for highlighting the financial aspect of recovery is so highly touted and that the results at sometimes are the secondary benefit. Just today a support staff was reporting to me that a certain counselor was spending money on something that they did not believe was part of the rehab policies. I spoke about the rehab in general that sometimes policies are grey and that they are designed to be able to assist people with real needs, and that probably the counselor has taken all aspects into consideration and is fortunate he/she is able to support the client.
DeleteI understand the importance of being fiscally responsible but it is important to understand at what cost?
Thanks Kaiti,
-Sean K
I noticed the focus on cost savings, too. I took a moment to look at the Treatment Advocacy Center's website, and they advocate for AOT, increased availability of psychiatric hospital beds, and civil commitment laws. It seems like all of the policies they advocate for somehow involve coercive treatment. There is a page on their website about 'Anosognosia,' which they define as, "lack of insight," a symptom of severe mental illness experienced by some that impairs a person’s ability to understand and perceive his or her illness." They call this the "the single largest reason why people with schizophrenia or bipolar disorder refuse medications or do not seek treatment," but use no evidence to back this claim up. They're essentially saying that people with mental illness are incapable of making decisions about what is best for them, and it seems like they would rather we go back to having big state hospitals to treat people instead of developing better community based treatment options.
DeleteI think it does become a tricky situation with the dangerous client example you spoke about because the public needs to be kept safe. If it is known that a dangerous person does not want treatment, do we just let them go out and continue to hurt people just because they don't want treatment? I also agree with you about clients having more say in their own treatment because I think it helps them in their recovery because they can own it instead of thinking someone else set it up for them. I do think there are ways of having freedom to choose treatment options when the person is willing to engage in services.
Delete-Lindsay Hill
Kaitlynn, I enjoyed reading your post and ultimately know how you feel having mixed emotions with the AOT programs. I believe that if clients are not harming someone or themselves psychically, they should not be forced on medication. All people should have the right to determine their treatment through an illness. There is so much stigma around recovery and mental illness. I agree with what you said about how society would be better off if we could eliminate stigma.
ReplyDeleteLike many others that have posted, the Assisted Outpatient Treatment (AOT) brews a lot of mixed emotions within in with valid points for both sides. Ultimately, if I had to chose one, I would chose to be for AOT. I do not feel as though AOT is necessarily a coercive model nor a "community asylum." I believe that AOT provides a holistic treatment and supportive approach to an individual who lives with sever mental illness/illnesses in the least restrictive environment. With what we have learned through this class so far as well as the deinstitutionalization movements, in-patient hospitalizations are not always necessary or even available. AOT provides a healthy, safe alternative that would allow an individual to receive a team approach of natural and formal supports which reaching their state of recovery. While the team is supporting an individual, the individual can begin to address any and all areas of their lives as well as work on things such as recovery (from mental illness symptoms and/or substance abuse), community involvement, pro-social interactions, reduction in recidivism (if applicable) all while living and being in a community setting. Lastly, I think providing treatment while in the community setting allows for a reduction in treatment regression as transitions may provoke set-backs. By receiving the support in the community, an individual can eliminate, at minimum, two transitions within their lives (in and out of an inpatient setting).
ReplyDeleteWith hope, the AOT approach can also education societal members and work towards reducing stigma towards individuals who live with mental illness.
Hi Ashley,
DeleteThanks for your comment ! I also agree that there could be benefits for patients in this program (such as a team of supports). However, I struggle with your thought that this program in not coercive in any way. To me, it is by nature coercive and forced upon a client, because it is court ordered. I wonder how much we are respecting a client by taking away their rights in this manner, especially for those who were not hurting themselves or anyone else.
Yeah my thoughts exactly Ashley, and I admire how you use the term eliminating two transactions. It is so true when we look back in our own lives there are many moments which have two parts to them and whether they are positive or negative we remember them separately, like each carries there own weight in significance.
DeleteAnother "tool in the tool box" for me, when I am having those conversation with clients,
thank you.
Sean K
Ashley, I agree with your thoughts about AOT services. I think it is the least restrictive and shows the most promise for a person to go through their recovery and rehabilitation. I think more education can be done about these programs and probably more partnering between community agencies and programs to help people succeed when they are participating in AOT services. While I think the short term hospitalizations can be necessary at times for certain clients, being able to live in their communities and learn how to access services in order to maintain their recovery is an important skill they can continue to carry on once AOT services are complete.
Delete-Lindsay Hill
Erin -
DeleteThank you for your response to my blog post. I appreciate you posting about your opposing views. While I agree that there can be a sense of coercion, I would like to point out that fact that AOT is not recommended/required lightly. These services are not for everyone, nor are they even offered to anyone. AOT is a services that is deemed appropriate under very specific circumstances including court appointed by a Judge. The assignment of AOT can only be done when they criteria is met, which is mighty hefty in itself. Also, at times, AOT is done to help prevent individuals from going into institutions such as Jail or Prison. This is especially helpful when the environment may be more detrimental to the clients' safety, emotional well-being and overall health.
-Ashley Williams
Sean,
DeleteThank you for your response and recognition of the positives I am highlighting with AOT. I think all programs we use within the social work field can have its positives and negatives, but as you mentioned -- all are tools in our tool box. While not everyone may be best suited for AOT, it is definitely useful for some and a benefit to have! Thanks again, Sean!
-Ashley Williams
Lindsay,
DeleteI think you are absolutely right! Additional education around AOT and its benefits would be so helpful for individuals, families and providers alike! At times, it can be hard to individualize treatment and/or treatment options for clients, especially in areas that have limited resources. So, as you mentioned in your comment above, I think there are times that hospitalizations are the most appropriate avenue for individuals who are in need for a crisis services and/or stabilization. With that being said, long term and additional options should always be available, too!
-Ashley Williams
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ReplyDeleteThe thing I first thought of when I looked over this poster is that I strongly dislike it when we use terms like "non-adherence" in regard to client plans of any kind. What this usually means that some provider came up with some plan that they think is best for the client, with varying levels of client input. To me, that term (and others like it, such as non-compliant) create a sense of judgey-ness (not a real word I know), a sense of what is right and what is wrong. And it is the person who has the most power in a relationship that is determining what is right and what is wrong (and that is likely not the client).
ReplyDeleteMy second thought after looking at the poster was that three out of the four agencies listed at the bottom under "broad support" were criminal justice system related. I think that that says something about this program and where its motivations are.
My third thought was that they seem awfully focused on medcaid recipients here. This tells me something that I already know - that people with financial means are less like to end up in a program like AOT than those without. It also tells me that many people who end up in this program are likely already stigmatized even before adding mental illness to the mix, because of being in some level of poverty.
On one hand, I can see where this is coming from. I myself have thought "wow, perhaps this client in front of me should be medicated." There are, without a doubt, clients that are extremely vulnerable to being taken advantage of because of their mental illness, especially when they are on the streets. I also do understand the need to cut costs where they can and helping to support staff who work in jails, EDs, hospitals. etc, when they keep really ill patients out of those places. I can think about this in two contexts - one with the system we are live in, and one in a different system completely. Perhaps AOT could be something that works for clients because it does respond to the mental health system we live in. It might help clients stay out of jails and homeless shelters where they might be further traumatized. It sometimes does seem easier to help a client survive the system better than working to change the system to treat them better.
However, if were able to dream up a system that is not built on oppression, misconceptions of mental illness, and stigma, there would be no place for something like AOT. In stead, we could come up with a way to treat folks without having to forcibly medicate them to conform to socially constricted standards of "living a normal life." We could have prisons that truly rehabilitate people and true treatment programs where folks are given choices about how they want to deal with their own mental illness. I know that this is me dreaming a little here, but I hope that one day we can work more toward a system like this.
Hi Erin, I cannot tell for sure if your point in regards to the criminal justice system is positive or a negative. However I wanted to comment to my thoughts on it, and that I was happy to see that some partners within the criminal justice system were on board. I believe too often in our society we have people of authority with little to no understanding of the people they are there to serve and protect. Hopefully with more community inclusion programs such as this agencies and community service partners alike will gain some education and insight how to treat people well, overall with a goal to really eliminate the needs for programs like AOT altogether. I tell my staff all the time, we are in a constant battle to do our selves out of a job, we are working on creating a system where there will be less recidivism and that we do not need to treat people in any way other than "normally".
Delete-Sean K
Hey Erin,
DeleteI noticed the slant in this bulletin related to criminal justice, as well! I really love this whole post, not only because you break down how we as practitioners need to act within the system on behalf of our clients, but also that we need to continue working towards a reality that looks very different from the one we're operating in now. Accepting this type of treatment as the end goal, or the "best that we can do" isn't enough - keep holding onto those dreams! We've seen throughout the course of this class how societal perspectives have shifted regarding people dealing with mental illness, and I think we can be a part of that movement by doing our best to push the needle forward in terms of respecting individuals with mental illness as the experts of their own experiences, deserving of all the rights and benefits afforded to the most privileged of us.
Erin,
DeleteIt is interesting to read your interpretation of the AOT poster posted on the blog this week. Like Sean and Meg, I am not sure where you stance is on the criminal justice system. Given your response of opposition under my blog post, I think I am safe to assume that you are not in support of AOT.
Prior to my current job as a Vocational Rehabilitation Counselor, I worked in an adult male prison for nearly four years. I can tell you that too often, there were individuals who could have benefited from a program such as AOT rather than a prison sentence. See, in the Maine prison systems, medication options are significantly limited, so at times, individuals can come across and under-medicated and/or over-medicated. I am not excusing criminalistic behaviors; however, I am saying that many times, individuals who lives with severe mental health disabilities did not even understand the totality of their actions, let alone why they were in prison. They were prime examples of how the AOT, community supervision program could have better suited their individual needs.
-Ashley Williams
Even though I haven't had the experience of working in the prison system like you, I think your observation makes sense Ashley. I think there are many current inmates that would do better with AOT services versus months of sitting in a county jail cell. I think right now there is a huge problem with co-occurring disorders that can make things more difficult for a person which is more reason why AOT services can be helpful for people. Especially if they committed crimes while under the influence of drugs and/or alcohol.
DeleteAOT does not seem to be in line with the principles of the recovery movement because it is coercive by nature. The recipients of this treatment do not seem to be able to make choices about their care within this model. However, as some classmates have mentioned in posts above, it's hard to think of a good alternative among the services that currently exist. One alternative is jail/prison, and that system is very likely ill equipped to support folks with mental health concerns. Prison as an alternative to AOT applies to people who have a history of violence, but what about the people who meet criteria for AOT just because of repeated hospitalizations? Shouldn't we be taking more time to overhaul the inpatient mental health system so that it does not result in so many repeated hospitalizations? AOT might be a better alternative than prison for folks experiencing distressing mental health symptoms, but I don't think it's a good solution on its own. It seems to me like a band-aid solution for a system that's broken.
ReplyDeleteBreanna,
DeleteI do agree with you that AOT should not be a sole solution or alternative to other treatment modalities. With that being said, I think that it should certainly be on the table as an option.
While AOT may not be a perfect substitute for in-patient hospitalizations, there is a point that I would like to state as to why it could be a suggested alternative. Many clients that I have worked with throughout my social work career have entered into a residential or in-patient hospitalization setting with a certain level of negative behaviors. More times than not, when they returned home, they had significant challenges with the transition AS WELL AS additional adverse behaviors. These were things that they witnessed other residents doing or talking about. For example, I worked with a young teenager with very risky behaviors. She would often run away, make risky choices (meeting people online), as well as many more. She ended up going into a residential unit for just over a year, and when she returned home, she began cutting as a way to release her emotional tension, something she had not done prior to. Given she participate in an intensive, community program such as AOT, she may not have gained the habits of cutting. Just some food for thought :)
-Ashley Williams
"It seems like a band-aid solution for a system that's broken." BINGO! I couldn't agree with you more, Breanna. Your post reminded me of a project I worked on in a social work class last year to investigate youth incarceration statistics in the State of Maine. We partnered with the Muskie School of Public Service to complete an asset-mapping project. Essentially, we as students were responsible for going out into designated communities and asking the question, "What structures or programs are already in place to stop kids from ending up in jail?" I think the policies that exist throughout the country are very reactive in nature - we set people up for failure and then penalize them when they do. In this instance, the State decided to look into alternatives to incarceration after the public reacted negatively to the news of a young transgender youth in Longcreek Youth Correctional Facility dying by suicide. This youth was dealing with mental illness, as well as all of the stressors that accompany jail. But how do we work to stop violence in our communities before it happens, rather than punish it when it does? Especially when it is done by a person living with mental illness? Although preventative measures certainly aren't the panacea I'm maybe talking them up to be, I think it's worth shifting the narrative a little bit and looking at other (perhaps international) models that address this in other, less coercive ways.
DeleteAssisted outpatient treatment model looks identical to what my clients on probation need to accomplish. I have mixed feelings about this because I think mandated counseling can be significantly beneficial- depending on the individuals motivation and willingness to learn. I also have seen the model fail because the amount of counseling, meetings to probation, and weekly meetings they are required to do leave little time to make enough money or little time to engage in personal wellness. The right of autonomy is not respected, but it helps engage the community into the individuals healing environment. While I think it is a good model for recovery, I believe it could be improved to add more resources to the individual until their life has stabilized.
ReplyDeleteBecca, I agree with you that it is hard for these programs to work in the gray at times and allow clients who may be doing really well to move forward and work more or reduce some portion of the treatment. It's hard when it is an all or nothing model. I like how you mention the engagement of the community, I feel if we do not have more acceptance and support within our communities then we are going to struggle to fully succeed.
Delete-Sean K
I like your perspective Rebecca since you are currently working with people who are mandated to receive counseling services. I agree with you, I think it all depends on the person and their motivation to change and willingness to learn to make changes in their life. I can understand how all the mandated meetings can significantly disrupt a person's life and almost seem to contradict the purpose of helping a person to recover. I'm sure the structure of the schedule of meetings can help a person to stay focused on completing treatment and begin to stabilize but I think as their recovery goes on, there would need to be flexibility to accommodate for employment, education, and wellness.
DeleteReading this AOT bulletin reminded me of the research I recently did for a class on alternatives to incarceration for juveniles who are dealing with mental illness, since the format and language seems geared towards an audience looking for an alternative to a punitive approach. The statistics and percentages provided seem designed to address the cost-effectiveness approach, which leads me to believe that this bulletin is, in essence, an advertisement of sorts. As many others have said, I have mixed feelings about AOT due to its coercive nature. I support the idea of a treatment plan that allows individuals dealing with symptoms of mental illness to stay in their home community, surrounded by all of their social networks, but the notion of court-ordered medication seems to violate individuals’ right to self-determination. Do I think AOT is preferable to incarceration or institutionalization? Yes. Is it the best that our society is capable of in terms of providing people living with mental illness with the support needed for recovery? Absolutely not. We as a society and we as providers (current or future) need to actively work towards destigmatizing mental illness and using our privilege to help people empower themselves when it comes to selecting a treatment plan that’s best for them.
ReplyDeleteMegan,
DeleteYour observation that this bulletin is an advertisement in nature is spot on. I hadn't considered that, but it was written in such a way that now, that is all I can see when I look at it. How frustrating is it that we are in a place now that we have to have ads the depict questionable treatment for people who may not understand what it really is. I agree that AOT may not be the worst place for certain people, but absolutely not if it violate's a non-violent person's rights. There must be a better way.
Kaitlynn Littlefield
I do not believe that AOT is recreating an asylum in the community. I think it helps people to use the services in their community while living in their community when they may not do so otherwise. Since AOT is targeted for people who have repeated hospitalizations and legal issues, I think it is the best option to keep people (client and general public) safe, help them stablize and not end up in a continuous cycle of hospital admissions and/or days in jail. I think it is a well known fact now that jails and prisons are not always the best options for people with mental illness and people can experience more symptoms being in that environment. Situations when people break the law and state it was because they are unstable due to their mental health become a tricky situation for mental health professionals and legal professionals. The general public needs to be kept safe and should feel safe which is why we have laws in place to protect everyone and punishments for those who break the law. I think people who are eligible for AOT services and want to engage in those services are receiving a better deal than being given a jail or prison sentence with no rehabilitation. If this treatment helps reduce hospitalizations, homelessness, arrests and incarceration, why is it being considered a bad service for people who are benefiting from it? There is always going to be room for improvement in any service that is provided for clients receiving mental health treatment but I think AOT services are better than the alternative lives people would be living if they didn't receive them.
ReplyDelete-Lindsay Hill
Lindsay,
DeleteYou raise a very good point in that AOT services are a way to treat individuals who have been dangerous to themselves or others, and that it is much better than being in a jail. While prisons are meant to rehabilitate those who have been sent there, often times resources are not available to really help them do this. AOT, if done right, could be a great option for the right person. I hope that it does not become a blanket/catch-all for individuals with disabilities, though. If used appropriately, I think AOT could be a tremendous turning point in a person's life.
Kaitlynn Littlefield