FAQ

Is involuntary outpatient commitment / assisted outpatient treatment necessary and inevitable?

Answer: No, most research on IOC/AOT with a true control condition (i.e. the same services offered to a control group without coercion / court mandate) finds no benefit of IOC/AOT. And secondary analyses of existing data have not been able to disambiguate the role of access to services (in non-controlled trials) from any potential "benefit" of coercion / court mandates.  

How can IOC/AOT harm recipients? 

In qualitative studies, recipients have reported numerous harms including stigma (and the internalization of stigma), harmful medication side effects, forced separation from family and loved ones, including minor children (e.g. when the order includes a "supervised residential treatment" requirement), and dehumanizing, objectifying treatment both during the court process and subsequent court-ordered treatment.  Importantly, not everyone has negative experiences of IOC/AOT but the harms must be weighed against benefits, especially when alternative approaches are in fact available.

What other harms can IOC/AOT lead to?

IOC/AOT normalizes the use of coercion and punishment in the treatment of mental health conditions: normalization-of-force that not only impacts service users but also providers and administrators.  Providers may come to rely on coercion rather than the often far slower work of building a relationship and earning the trust of individuals who often carry a long history of trauma and harm. At a societal level, arguments in favor of IOC/AOT often play on harmful stereotypes linking mental illness with violence and unpredictability, fueling stigma and discrimination in ways that reach far beyond the relatively small number of individuals directly impacted by IOC/AOT orders.  And at a systems level, once IOC/AOT programs are in place and create pathways for guaranteed or prioritized access to services (often including Assertive Community Treatment and housing vouchers), caring providers will route service into IOC/AOT, given no other way to gain access to needed supports. 

What are the alternatives? 

Current/former services users who end up in IOC/AOT often describe long histories of coercion, dehumanization and disrespect in the course of years of interactions with mental health, substance use, social welfare and criminal legal systems.  The most far-reaching "alternative" entails fixing the broken systems and services that lead to harm, rather than blaming the victims of these systems and stripping them of civil rights.  This means: holistic, psychosocial services that meet service users where they are at from the first moment they enter the system, working with experiences such as psychosis in ways that center individual and collective meaning-making, and focusing on the therapeutic relationship.  And this means addressing the underlying social and structural conditions that often account for far more of the distress individuals experience than their symptoms, namely poverty, housing precarity, food insecurity and barriers to full participation in work, school and the civic life of the community. 

When it comes to specific service models, programs like CORE+ and PROS in New York are strong exemplars, providing intensive community-based support in the case of CORE and recovery-oriented drop-in centers in the case of PROS.  The INSET model, peer-led, team based proactive outreach and support for individuals at risk of IOC/AOT holds great promise and, even when participants do end up with an AOT order, ensures access to independent advocacy and support.