Features and News

(July 2, 2019) Assisted outpatient treatment (AOT), a form of court-ordered community care for individuals with serious mental illness, may be effective even without the use of intensive case management services, according to new research out of Summit County, Ohio.

For individuals who lack insight into their mental illness or are too sick to seek treatment on their own, AOT can stop the revolving-door of hospitalization or criminal justice involvement by motivating them to fully engage with treatment providers in the community. For a variety of reasons, this population of people with severe mental illness can be difficult to reach, and may be experiencing a host of complicating circumstances such as co-occurring disorders, homelessness, or poverty. As a result, AOT is often paired with assertive community treatment (ACT), an evidence-based program built upon intensive case management and designed specifically for similar populations. ACT is considered the “gold standard” of intensive outreach services and been shown to be beneficial in reducing unnecessary hospitalizations and maintaining treatment plans for individuals with a history of non-adherence.

However, available research on AOT programs has not determined whether ACT services are necessary to ensure the efficacy of court-ordered treatment. Using data generated from the Summit County, Ohio AOT program between 2000 and 2007, a team of researchers led by Mark Munetz, M.D. of Northeast Ohio Medical University, analyzed outcomes of 74 individuals receiving AOT both with and without accompanying ACT services, for a period of at least six months. Observed data included the amount of case management received during treatment, as well as the number of psychiatric hospitalizations and hospital days before, during, and after treatment.

Over the course of treatment, both those in the AOT without ACT group and the AOT with ACT group received substantial case management services, but the non-ACT group received less than half that of the ACT group.

In terms of hospitalizations, both groups saw reductions in number of hospitalizations and days hospitalized compared to the year prior, with some reductions maintained even after the end of the court order. Notably, the group who received AOT without ACT maintained a slightly greater reduction in the number of hospitalizations and a significantly greater reduction in days hospitalized following treatment compared to the group receiving AOT with ACT.

Ultimately, according to the researchers, the Summit County data provides evidence that AOT can be effective in reducing hospitalizations and hospitalization days, even when not paired with the intensive case management provided by an ACT team. Considering ACT is not widely available throughout the United States, the findings suggest localities may implement AOT programs and sufficiently serve a subset of individuals with serious mental illness, even without the presence of ACT services.

References: