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Is this the best way to care for patients with severe mental illness?

Does court-ordered treatment for mental illness work?

Judge Elinore Marsh Stormer in her courtroom, speaking with a man who is part of Summit County’s assisted outpatient commitment program.
Jillian Weinberger/Vox

What is the best way to care for patients with severe mental illness?

The United States has struggled with this question for decades.

Just a few weeks before his assassination in 1963, President John F. Kennedy signed the Community Mental Health Act, a law that began the process of discharging patients from mental institutions. Physicians at the time believed that they could treat the mentally ill effectively in community mental health centers instead of in mental hospitals — in part because of new advances in psychopharmacology.

The new law did not include long-term federal funding for those community mental health centers, though. And in 1981, President Reagan signed legislation that transferred responsibility for caring for those with mental illness onto the states. It included a state block grant program, but federal funding for those grants has declined significantly over time.

Today, a lot of mentally ill patients end up in prison, jail, or homeless. One recent study found that more than half of all inmates have some kind of mental illness, and about a quarter of the homeless population suffers from mental illness.

A number of communities across the country are trying a different approach: court-ordered outpatient treatment. It’s often called Assisted Outpatient Treatment, or AOT for short.

The research on AOT is limited and mixed, but a handful of studies back up that assessment. That data was convincing enough for the federal government: One of the last pieces of legislation President Barack Obama signed before he left office included millions of dollars to spread the AOT model all across the country.

But AOT is controversial because it involves force. A lot of psychiatrists believe that means it will never work in the long term.

On this episode of The Impact, we went to Summit County, Ohio, to see this model in action. We met a judge who has dedicated her career to this model, a patient in the midst of treatment, and a graduate of the program who has had mixed results. We also talked to a psychiatrist who’s skeptical of this treatment model — and the now-former Congress member who believes it’s the best way to care for those with mental illness.

You can read more about our trip and Jillian’s reporting here.

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