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Assisted Outpatient Treatment
The Assisted Outpatient Treatment Program
Enacted in 2016, the Assisted Outpatient Treatment Act, § 43-1B-1 et seq., provides for a municipality to enter into a memorandum of understanding with its local district court to establish an AOT program which provides, under specific circumstances, for involuntary court-ordered admission to a program of community-based behavioral health services. In 2017, the City of Albuquerque, with the support of an advisory team, began the planning process to implement an AOT program. Thereafter, the City of Albuquerque was awarded a multi-year grant in October 2018 from the Substance Abuse and Mental Health Services Administration (SAMHSA).
The Assisted Outpatient Treatment Program is a new civil court program to facilitate the delivery of community-based behavioral health treatment to individuals with a serious mental disorder. Individuals receiving AOT services participate in a civil court process. To be considered for AOT, individuals must meet specific criteria, including a history of non-adherence with voluntary treatment for their mental health diagnosis. Individuals participating in the AOT program must be able to live safely in the community with the support of comprehensive community-based mental health services. It is a 2-way commitment that requires treatment providers to serve individuals at the same time it commits individuals to adhere to their treatment plans. Through the ritual of court hearings and the symbolic weight of a judge’s order, AOT seeks to leverage a “black robe effect,” motivating the individual to regard treatment adherence as a legal obligation. AOT employs a recovery-focused approach that promotes wellness, self-management, shared decision making, natural supports, coping skills, self-advocacy, and development of independent living skills.
The goals of AOT include: preventing harmful outcomes such as relapse resulting in hospitalization, homelessness, incarceration, and trauma, while supporting individuals in maintaining stability and achieving personal goals.
AOT is recognized as an evidence-based practice by the National Institute of Justice, Office of Justice Programs; the Substance Abuse and Mental Health Services Administration (SAMHSA); and the Agency for Healthcare Research and Quality (AHRQ). Its use is also endorsed by the American Psychiatric Association, American College of Emergency Physicians, International Association of Chiefs of Police, National Sheriffs’ Association and National Alliance on Mental Illness.
What is Assisted Outpatient Treatment or AOT?
“Assisted outpatient treatment” is defined as categories of community services ordered by a district court, including case management services, care coordination or assertive community treatment team services, prescribed to treat a person’s mental disorder and to support them in living in the community, or to attempt to prevent a relapse or deterioration that may reasonably be predicted to result in harm to the person or another or the need for hospitalization. Assisted outpatient treatment may include:
What are the specific criteria for an individual to be considered for AOT?
Specific criteria for an individual to be considered for the AOT program include:
- Been a significant factor in their hospitalization or incarceration at least twice in the last four (4) years; or
- Resulted in one or more acts of serious and violent behavior toward self or other, or threats of, or attempts at, serious physical harm to self or others within the last four (4) years; or
- Resulted in incarceration, detention, or hospitalization for six (6) months or more and the person is to be discharged within the next thirty (30) days or was recently discharged within the past sixty (60) days;
- Is unwilling or unlikely to participate voluntarily in outpatient treatment; and
- Without which the person is unlikely to live safely in the community without court supervision;
- the least restrictive appropriate alternative; and
- needed to prevent a relapse or deterioration likely to result in serious harm to self or others;
Who can request AOT?
- An adult roommate of the person;
- A parent, spouse, adult child or adult sibling of the person;
- The director of a hospital where the person is hospitalized;
- The director of an organization where the person lives and provides mental health services to the person;
- A qualified professional who is providing or supervising the person’s mental health treatment or has supervised or treated the person within the last 4 years; or
- A surrogate decisionmaker, such as a power of attorney or guardian
How are individuals referred to the AOT program?
The AOT program is not currently accepting referrals. The City is working to procure clinical services and is seeking qualified professionals (https://www.cabq.gov/family/documents/qp-rfil-final.pdf). We remain eager to resume operations as soon as possible. A description of the referral process will be outlined in the near future.
How is “mental disorder” defined?
A “mental disorder” means a substantial disorder of a person’s emotional processes, thought or cognition that grossly impairs judgment, behavior or capacity to recognize reality, but does not mean developmental disability. See NMSA § 43-1-3(O)
What does “likely to result in serious harm to self” mean?
“Likely to result in serious harm to self” means that it is more likely than not that in the near future the person will attempt to commit suicide or will cause serious bodily harm to the person’s self by violent or other self-destructive means, including grave passive neglect. § 43-1B-2(I).
What does “likely to result in serious harm to others” mean?
“Likely to result in serious harm to others” means that it is more likely than not that in the near future a person will inflict serious, unjustified bodily harm on another person or commit a criminal sexual offense, as evidenced by behavior causing, attempting or threatening such harm, which behavior gives rise to a reasonable fear of such harm from the person. § 43-1B-2(H).
What is a “qualified professional”?
A “qualified professional” means a physician, licensed psychologist, prescribing psychologist, certified nurse practitioner or clinical nurse specialist with a specialty in mental health, or a physician assistant with a specialty in mental health. § 43-1B-2(O).
What is the “least restrictive appropriate alternative”?
The “least restrictive appropriate alternative” means treatment and conditions that: (1) are no more harsh, hazardous or intrusive than necessary to achieve acceptable treatment objectives; and (2) do not restrict physical movement or require residential care, except as reasonably necessary for the administration of treatment or the protection of the patient. § 43-1B-2(G).
What are the individual’s rights in the process?
AOT strictly defines eligibility criteria in an effort to ensure appropriate application of the law and to protect individual rights. The law specifically defines the rights of the individual who is subject to AOT, including participation in the development of a treatment plan, adequate notice of hearings, to receive a copy of the court‐ordered evaluation, the appointment of an attorney, to be present at the hearing, to present evidence and call and/or cross‐examine witnesses, and to appeal decisions.
How long is a person committed to AOT?
A civil court can grant an AOT order for up to one (1) year. Prior to the order expiring, the AOT Team may determine ongoing need and benefits of the AOT program and apply to the court for continued services. If agreed upon by the court, the order for AOT may be renewed for another year.
What happens if an individual receiving AOT services does not comply with their treatment plan/the court order?
AOT cannot force an individual to take medications. If an individual participating in AOT is not complying with any aspect of their treatment plan, the AOT Team will make every attempt to positively re-engage that person. If an individual is unable to positively re-engage in the AOT program and is at risk of harm to self or others, the AOT Team may request a court order for involuntary transportation for an evaluation, including inpatient psychiatric hospitalization.
Telephone: (505) 841-7560