Clarification on Assisted Outpatient Treatment (AOT)
I cited Natasha Tracy’s post on AOT a few days ago, and got some intense feedback. I’d like to clarify my position. I fully understand people’s mistrust of system interventions and compelled treatments and the proverbial slippery slope they believe such treatments represent. But after working on the front lines of direct services to people with chronic mental illness, I believe you might feel differently—at least in some cases.
No one is advocating AOT for every person who has been diagnosed with a mental illness. That’s not how things work. People who are monitored under AOT have met certain criteria, like committing a criminal act. It is unfortunate that people’s illnesses do infrequently cause them to commit illegal acts, but when they do, they must—like every other person in our society—be held to account for those actions. Because we don’t want them to just be thrown in jail without considering their health problems, we find alternative ways to address issues of safety and accountability.
AOT for someone who has committed a crime is not, in my opinion, a slippery slope to someone like me—diagnosed with bipolar disorder—being forced to submit to similar conditions in my everyday life. I think the invocation of the slippery slope is a lazy rhetorical device employed by people who are afraid and angry, sometimes justifiably so. But is it borne out by facts? I don’t believe so.
A couple years ago I was the manager of a peer support program for a mental health organization. The goal of the peer support program was to reduce repeat hospital visits for “frequent flyers,” as the hospitals so sweetly called them. This reduction in hospital visits had an obvious benefit for the people we worked with. And I don’t think anyone objecting to AOT, which has the same goal in many cases, would object to peer support. There are many different tools we use to make lives better for people who have been diagnosed. Those who live in extremis due to their illness—those who are homeless, or who spend every weekend in the ER—need bold intervention.
I have a friend who runs an Assertive Community Treatment (ACT) program. Some people object to ACT for the same reasons they object to AOT. But my friend has seen people’s lives change radically—especially people living in poverty who were unable to manage their own resources. Sometimes in our zeal to protect rights in general, across the board, we forget about the individuals who are suffering on a daily basis. Should someone who lives in poverty and can’t get food because of his delusions prevent him from processing the complexity of government paperwork for food stamps be denied help so the rest of us can preserve our rights—which we only theorize are being threatened?
I am no fan of E. Fuller Torrey or TAC. I think he’s terribly destructive. He does not allow for subtlety. He has a twisted agenda. He’s a dangerous guy. I am not endorsing his positions, and I didn’t mention him—though someone affiliated my remarks with him. I do endorse careful, responsible consideration of practices that may help individuals in a system that continues to underserve them.
liz | 10:16 AM | alternative treatments, hospitals / hospitalization, ACT, AOT, forced treatment, laura's law
But… the big picture is that this Fuller Torrey promoted system has crawlers of his beliefs, and it CAN get worse! I wouldn’t trust that not everyone w MI label won’t be involved at some point, because unless a person is under the radar, these policies and laws are then in place for times when someone ‘busts out’ and the staff, doctors, SW involved on someone’s case can implement. I heard Torrey speak at a NAMI talk on purpose to take notes and see what the guy was all about and trust me the NAMI folks think he is a gift to the world! They had only ONE ‘expert’ talk abt SZ and it was him. With all of his views being applauded and he lumped SZ and Bipolar together, saying everyone has this stuff it’s all just laying dormant in us like a lurking virus! So when we read labels on packages saying “endorsed by…” this might as well have a label saying “endorsed by E.Fuller Torrey”.
you state, “People who are monitored under AOT have met certain criteria, like committing a criminal act. It is unfortunate that people’s illnesses do infrequently cause them to commit illegal acts, but when they do, they must—like every other person in our society—be held to account for those actions.” this is not necessarily the case–and the fact is this agenda has been pushed across the Nation even though it is based on assumptions not facts. The fact that there is virtually no accountability for mental health professionals who abuse their authority, by stating that the drugs are “medically necessary” to treat “brain based diseases”—when this claim is made in the absence of valid evidence this is true–when used in a Court of Law, the claim is specious; and does not meet the standard required in the Rules of Evidence, and should always be challenged. There is no accountability for the harm caused by AOT, ACT indeed there is no accountability for the lack of Informed Consent, or the inefficacious drugs which these programs insist are necessary when they are only “effective” for a small minority of people with a diagnosis of schizophrenia.
From the Cochrane Library an abstract on a this type of program: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004408.pub3/abstract
“We found little evidence that compulsory community treatment was effective in any of the main outcome indices: health service use (2 RCTs, n = 416, RR for readmission to hospital by 11-12 months 0.98 CI 0.79 to 1.2); social functioning (2 RCTs, n = 416, RR for arrested at least once by 11-12 months 0.97 CI 0.62 to 1.52); mental state; quality of life (2 RCTs, n = 416, RR for homelessness 0.67 CI 0.39 to 1.15) or satisfaction with care (2 RCTs, n = 416, RR for perceived coercion 1.36 CI 0.97 to 1.89). However, risk of victimisation may decrease with OPC (1 RCT, n = 264, RR 0.5 CI 0.31 to 0.8). In terms of numbers needed to treat (NNT), it would take 85 OPC orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest. The NNT for the reduction of victimisation was lower at six (CI 6 to 6.5).”
It just may be that providing social support services without using coercion, subterfuge and Court Orders to gain psychotropic drug treatment compliance may effectively help, and may be all that is needed—e.g. be kind, tolerant, respectful, specifically, have genuine, positive regard for those with a psychiatric diagnosis whom one hopes to help. Being dishonest about the nature of a psychiatric diagnosis and exaggerating the efficacy while minimizing the serious risks involved in taking them has caused a great deal of mistrust. Using coercion, while claiming the drugs are effectively treating biological DISEASES is not only inaccurate; it is a claim without any basis in fact. It is this claim that is being used to further a biased agenda, and as an attempt to validate Standard Practices which are not based on the data derived from clinical trials, but are based on subjective opinions–characterized as being, “anecdotal evidence.” I’m thinking that more should be required for Public policy and more should definitely be required to compel Court Ordered “treatment” which has the potential to disable or kill the person who receives it. The lack of validity of the data on which these programs are based, and the fervor with which proponents advocate for them definitely belies the true nature of these psychiatric drug compliance programs. They are not programs of ethical or benevolent assistance for “the seriously mentally ill.”
*risks involved in taking the drugs has caused a great deal of mistrust.*
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