Is Massachusetts getting closer to an AOT law?

Support in CT for measure is non-existent

As the formal legislative session in Massachusetts ended in July, it became clear one bill would not find its way to the governor’s desk for signing, or at least not this year.

Massachusetts and Connecticut are the only two states in the country without a law allowing for Assisted Outpatient Treatment (AOT), also known as Involuntary Outpatient Commitment (IOC). The law would provide a path for requiring certain individuals to adhere to a community-based treatment plan.

Support for an AOT law has been practically non-existent in Connecticut, where it has not even been on the state’s psychological association’s lobbyist radar in recent years.

Meanwhile, debate in Massachusetts has continued over the past decade with growing support and also strong opposition to the passage of a law. The most recent attempt, H1694/S980, did not make it out of committee in the 2023/2024 session.

“We did a lot of advocating this time around and I think this was the furthest it has gone [in the process,]” said Representative Mathew Muratore (R-Plymouth). “If I am re-elected, I will be sure to file it again and if not, I am sure that someone else will. We are one of two states that doesn’t have this and we really need to get this in place.”

The Massachusetts bill as written this past session would apply to those whose situation poses a health or security risk to themselves or others or who demonstrate severe deterioration in functioning.

It also would apply to people who have a history of noncompliance with a treatment plan and have required hospitalization or incarceration at least twice within the previous 36 months or committed one or more acts of “serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others.”

High-profile cases of those with serious mental illness (SMI) harming or killing others are often a major argument in support of a bill.

Supporters of AOT laws also claim they help individuals avoid hospitalization, incarceration, homelessness, and physical harm and support their ability to live a productive life in the community.

“It’s providing proper care,” said Shawn Duhamel, a lobbyist for AOT Now, a Massachusetts-based group working to improve mental health care and access. “We know there is this endless revolving door at hospitals and that more than half of the population in county jails are suffering from an SMI. The system is failing them as it currently stands. We have to do better.”

The American Psychological Association supports AOT, stating that “It can be effective when accompanied by adequate resources and intensive, individualized outpatient services.”

Opponents in Massachusetts point to the existence of a special court-ordered guardianship, known as Rogers Orders, as making an AOT law unnecessary.

Under Rogers Orders, the court appoints a guardian to oversee treatment for an incapacitated person. The order usually “refers to treatment with antipsychotic medication, but it may include other intrusive treatments and procedures” according to the Massachusetts Court System website.

Originally created to protect patient’s rights in treatment facilities, the orders can cover either inpatient or community-based treatment.

Rather than investing funds in developing new programs to support AOT, said Danna Mauch, president and CEO of Massachusetts Association for Mental Health, the state should invest in better access to community care, affordable housing, and food security.

“If we do not make investments in these services to make the system more accessible and more accountable, you are going to continue to have people who can’t get timely access to treatment and then things deteriorate,” said Mauch.

MAMH supports clarifying the processes for obtaining Rogers Orders.

“We would ultimately favor working to make the Rogers process more understandable and accessible to people,” said Mauch.

Mauch also questions the possibility of restricting people’s civil rights and the efficacy of AOT laws as enacted in other states.

“The data shows that it doesn’t necessarily result in more people receiving care,” said Mauch. “The kinds of tragic situations that the proponents of this bill call out are still arising in these other states despite the presence of these laws.”

Across New England, AOT laws have had varied results according to how they are implemented.

The Treatment Advocacy Center (TAC), a national nonprofit that promotes AOT, rates each state on its delivery of mental health care via involuntary commitment laws.

Vermont has an A+ while Maine and New Hampshire have grades of C-. Massachusetts and Connecticut could be expected to earn an F because of the lack of an AOT law, but Rhode Island also scores an F, in part, because procedures are not sufficiently detailed for providers.

“The implementation of AOT comes down to the local jurisdictions in most states,” said Leslie Carpenter, TAC’s legislative advocacy manager. “Some of these programs are operating at a higher level than others.”

The TAC has an implementation team that works with states to develop AOT support systems, said Carpenter.

“AOT improves the person’s outcome in terms of their ability to live independently in the community,” she said. “It helps to take care of the people who are otherwise being left to suffer in their psychosis and experience increased rates of homelessness, incarceration, and death.”