A resolution for 2017: Giving serious consideration to outpatient treatment

Private hospitals and related care facilities should take note: 2017 is a pivotal year for outpatient treatment. Following a federal grant awarded to Cook County Health and Hospitals System, certain state facilities are now able to fundamentally reconfigure how they administer care to individuals with severe mental illnesses through Assisted Outpatient Treatment (“AOT”).1 Providers should embrace this momentum or risk idling in the past, unequipped to navigate an evolving landscape where outpatient care is readily pursued and administered. What’s more, unencumbered by the contours articulated by the AOT grant, private providers have the ability to craft creative solutions within the existing statute allowing outpatient treatment. This article highlights the new Cook County Assisted Outpatient Treatment Program and is meant to spur further contemplation and dialogue among those providers not participating in the program about how outpatient treatment demands serious consideration now, more than ever.

Background

As stated in the initial funding opportunity announcement, this new program “is intended to implement and evaluate new AOT programs and identify evidence-based practices in order to reduce the incidence and duration of psychiatric hospitalization, homelessness, incarcerations, and interactions with the criminal justice system while improving the health and social outcomes of individuals with a serious mental illness (SMI).”2 The project is “designed to work with families and courts, [and] to allow these individuals to obtain treatment while continuing to live in the community and their homes.”3 Initial facility-participants in the AOT project are Chicago-Read Mental Health Center, Madden Mental Health Services and Cermak Health Services. It is a four-year grant and aims to serve 100 individuals per year.

There are several obvious and immediate benefits of the AOT program. One benefit to both respondent and facility is that the project tackles the issue of repeated admissions head-on. In other words, AOT is designed to augment an individual’s treatment where it is needed the most: in the community. By not abruptly ceasing care at the facility’s exit doors, these state centers mitigate the unfortunate risk of seeing the same client weeks later at intake. Additionally, the AOT project specifically involves the respondent and invites each individual, through counsel, to have input into his or her own care. The opportunity for agreed orders and participation in the process can be pivotal to individuals that routinely have no say in their care.

Eligibility

Screening for AOT eligibility generally occurs at the outset of patient intake. Individuals experiencing a severe mental illness may qualify for AOT if they are over the age of 18, a resident of Cook County, and have a history of non-compliance with treatment as well as recent (within 12 months) admissions to psychiatric facilities.

Process

A case manager will coordinate most of the substantive sequences for AOT-eligible individuals. Such AOT events involve contacting the proposed custodian of the individual and may even include having members of an Assertive Community Treatment (“ACT”) team meet with the respondent prior to any discharge. Such instances can bolster the program’s credibility in the eyes of the AOT-respondent and provide much-needed familiarity to an otherwise opaque concept.

AOT may be pursued by petition through adversarial hearing4 or by agreement.5 Those practitioners involved in the AOT program (this author included) are optimistic that the majority of AOT petitions will be by agreement. Even if such outpatient care is sought by agreement, the Court will apply a variety of safeguards such as reviewing the written report, assessing the custodian’s understanding, and further ensuring the respondent is informed of the agreement’s conditions. If the agreed order contemplates medication, then an additional determination by the Court is required.6

An agreed outpatient order remains enforceable for 180 days with the possibility of an agreed extension.7 Throughout this period, the individual is represented by counsel and status updates are provided to the Court regarding the individual’s progress, including any compliance issues. Non-compliance with an agreed care and custody order may result in the custodian orchestrating the respondent’s return to a facility where the individual may be admitted as voluntary.8

Conclusion

The AOT project provides infrastructure and opportunity for mental health practitioners in the form of a long-ignored method of treatment. Indeed, many would argue that outpatient treatment is a frontier that should not be a “frontier” at all. Consequently, it is time to resolve to embrace a treatment that can fundamentally bridge the gap between hospital and home so that more individuals (and facilities) can break an outdated cycle of inpatient admissions and frustration.

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Matthew R. Davison is contract counsel for Legal Advocacy Service, a division of the Illinois Guardianship and Advocacy Commission. Pursuant to the AOT grant, he represents respondents throughout the AOT process. He may be reached via email at Matthew.Davison@illinois.gov and by phone at (847) 272-8481.

1. Other grantees include facilities from Alabama, California, Florida, Kentucky, Maryland, Mississippi, Nevada, Ohio, Oklahoma, Puerto Rico, Texas, Utah, Washington, and Wyoming.

2. http://www.samhsa.gov/grants/grant-announcements/sm-16-011 (last visited December 20, 2016).

3. Id.

4. Involuntary admission on an outpatient basis may be sought for an individual that is either:

A person who would meet the criteria for admission on an inpatient basis as specified in Section 1-119 in the absence of treatment on an outpatient basis and for whom treatment on an outpatient basis can only be reasonably ensured by a court order mandating such treatment;

or

A person with a mental illness which, if left untreated, is reasonably expected to result in an increase in the symptoms caused by the illness to the point that the person would meet the criteria for commitment under Section 1-119, and whose mental illness has, on more than one occasion in the past, caused that person to refuse needed and appropriate mental health services in the community.

405 ILCS 5/1-119.1.

5. See 405 ILCS 5/3-801.5.

6. See 405 ICLS 5/3-801.5(a)(5).

7. See 405 ILCS 5/3-801.5(g).

8. See 405 ILCS 5/3-801.5(b).