At the end of November, the Children's Mental Health Network convened a group of mental health advocates in the conference room of Minority Whip Steny Hoyer for the third of four dialogues on Assisted Outpatient Treatment (AOT). You can read about that meeting here. One of the action items that emerged from the November dialogue was the idea of visiting a community that utilizes the AOT process in a way that would be supported by proponents of the Helping Families in Mental Health Crisis Act.
Well, good news Network faithful - plans for our visit to a community that utilizes the Assisted Outpatient Treatment (AOT) hearing process are in the final stages, and we could not be more excited.
The AOT issue is one component of the Helping Families in Mental Health Crisis Act that has been a consistent lightning rod for controversy. Championed by Representative Tim Murphy (R, PA-18), the proposed bill has dominated the conversation in mental health circles over the past year, leading to divisive splits among advocates about what should be included in any comprehensive mental health reform bill. The bill (HR 3717) didn't go anywhere in the last Congress, but support is growing with members of Congress, and Representative Murphy is continuing the aggressive pace from last year for garnering support among his congressional colleagues.
Why is the Children's Mental Health Network organizing a community dialogue on AOT?
Quite simply, the judicial system in in the community we are going to visit utilizes AOT in a way that represents an example of the type of approach supported by proponents of The Helping Families in Mental Health Crisis Act. If we are going to be constructive in our approach to this bill, we need to touch, see and feel one of the more controversial components.
Focusing on this particular community does not, and should not, imply that they are “perfect” in their approach to meeting the needs of individuals with serious mental illness and their families. But they are trying to make it work, and at the end of the day, warts and all, that is what we need to see. Only then, can advocates who come to the AOT dialogue with polar opposite views, have a constructive dialogue about AOT from a shared experience.
Who will participate in the dialogue?
Thanks to all of you who wrote in requesting to participate in the onsite dialogue. Please know that there will plenty of opportunities for involvement in CMHNetwork dialogues, but for this one, which is the fourth and final dialogue on AOT, we are purposely keeping the invitations focused on those who have participated in at least one of the three previous dialogues. We are doing this for continuity, and frankly to keep our numbers small for this highly personal and intimate experience.
Where is the visit taking place?
We will not share publicly the location of the community we are visiting until after we complete the visit. This is an emotionally charged topic, and just as dialogue participants at the extremes of opinion have come together in mutual respect, we want to ensure that the same level of respect extends to those we will be meeting with. We want to experience this on-site visit with as little extraneous chatter as possible.
Structure of the visit
You can likely imagine the logistical challenges for a visit such as this. Here is a rough idea of how we will spend our time.
- Morning session
We will spend the morning observing the cases that come before the judge. After the morning session, we will conduct a lunch meeting where we will get the opportunity to meet with judicial staff, the mental health liaison and other providers involved in the particular cases we will be observing. For obvious reasons, we will not be meeting with individuals involved in the hearings or their family members.
- Afternoon / evening session
Our goal is to meet with extended service and support options typically identified an an AOT treatment plan. I will be working with mental health liaisons from the community to identify representatives from family and young adult support organizations, peer-led service providers and others who comprise the extended elements identified in treatment plans utilized in the AOT process. It is most important that we understand how this community looks at the connection between highly intensive and less intensive services and supports. Also, a high priority for me is to identify a young adult and family members who have been through the process before. Fingers crossed on this one!
Confidentiality and consent
Confidentiality and consent are our highest priority for this visit. We can expect at least a four-week time span between our request (coming this week) and the actual visit. All individuals and family members involved in the court process need to give their permission in order for us to sit in, so this visit will take some time and ongoing communication to get set up. But it will be worth the wait!
Benefits and challenges for dialogue participants
Let's make no mistake folks - for dialogue participants who choose to participate, this visit will likely make them uncomfortable, regardless of their position on AOT. Dialogue participants to date represent a number of national advocacy organizations - some with clearly defined positions on AOT and others who have members with widely divergent opinions on AOT. It is highly likely (based on past dialogues) that participants will hear a fair amount of constituent questioning of motive for participating.
- For dialogue participants who are ardent supporters of AOT, they will celebrate the opportunity to hear from community partners who embrace a process that ensures treatment for the small percentage of individuals with mental illness who don't have the awareness to make that decision for themselves.
- For dialogue participants who are ardent opponents of AOT, they will likely celebrate the opportunity to hear from community partners who embrace the benefits of peer-led, supportive services that focus on individual choice for the overall population of individuals with severe mental illness.
- For or against, those who participate in this dialogue will see and hear from one community that is trying to make both ends of this continuum work together.
Bottom line - participating in this visit is not for the faint of heart
I hope this gives you insight into the strategy in play as well as the risk I am asking these advocates to take. But let's face it - if we are not willing to risk public critique, then we might as well stay home and twiddle our thumbs, and let decisions about mental health reform be made without our input. It is more than past the time that we hitch up our britches and move this dialogue forward.
A reminder of why the dialogue series began with AOT
Even though AOT is only a small part of the overall Helping Families in Mental Health Crisis Act, it is the component most often cited and linked to other elements of the bill, specifically the reorganization of SAMHSA and redirection of federal dollars - i.e., "If HR 3717 was in place, this tragedy would not have happened, we need to shift focus of federal investment."
AOT raises fervent questions on both sides, and as we have learned in our three dialogues to date, is misunderstood, misconstrued, highly variable in approach, and more often than not, discussed out of context and in isolation of the broader continuum of services and supports necessary to help individuals with serious mental illness integrate into the community. We have talked a lot about AOT. It is time to do some listening where AOT has the most impact - in communities where families, individuals and providers deal with the issue, not in the abstract, but up close and personal. And that is what we need to understand if we are to guide the development of meaningful and comprehensive mental health reform in America.
Stay tuned Network faithful!
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President & CEO
Children's Mental Health Network