Individuals with serious mental illness who received assisted outpatient treatment (AOT) experienced improvements across a broad range of clinical outcomes, including adherence to treatment, symptoms, and self-reported quality of life, according to a report in Psychiatric Research and Clinical Practice. They also had substantially fewer episodes of violent behavior, arrests, and rehospitalizations.
The length of mandated treatment was also found to be important, noted Kiersten Johnson, Ph.D., of RTI International, and colleagues.
Court-mandated AOT extends the state’s civil commitment authority from hospital‐based care to outpatient services, including managed pharmacotherapy, intensive case management, and, often, access to subsidized housing. A 2020 position statement by the APA Board of Trustees endorsed AOT, saying that it “can be a useful tool in the effort to treat patients with severe mental illness with clinical histories of relapse and re-hospitalization.”
The researchers analyzed data on 392 patients receiving mandated treatment at six AOT sites across the country. The primary data came from structured clinical interviews with participants conducted at baseline and at six‐ and 12-month follow‐ups. Three of six sites provided supplemental data on Medicaid/non‐Medicaid service encounters, local/state arrest records, and/or public/private hospitalization data.
Patients who completed AOT had significant improvements in their psychiatric symptoms (as assessed using the Modified Colorado Symptom Index), perceived mental health, life satisfaction, and therapeutic alliance. Appointment adherence increased by more than 24%, while medication adherence increased by 20%. Additionally, violent behavior was reduced by more than 19% and suicidal ideation by more than 24%. Illicit drug use and risk of homelessness also decreased following AOT completion.
The average length of an AOT order with renewals was 228.7 days. Compared with patients who had an AOT order of less than six months, those with orders of six months or longer experienced greater reductions in likelihood of violence (24.5% versus 14.7%), suicidal ideation (27.4% versus 21.4%), and inpatient hospital nights (14.5 fewer nights versus 8.3).
“There were no noted differences in outcomes between those who are referred from the community (step‐up) and from inpatient hospitalization or jail stay (step‐down),” Johnson and colleagues wrote. “In contrast, criminal justice involvement at time of initiation of the AOT order was associated with subsequently greater reductions in violent behavior and arrests, suggesting that this population is within the scope of AOT’s effectiveness.”
For related information, see the Psychiatric Services article “Association Between Hospitalization and Delivery of Assisted Outpatient Treatment With and Without Assertive Community Treatment.”
(Image: Getty Images/iStock/Dacharlie)
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