A person may have an Assisted Outpatient Treatment (AOT) order granted on his/her behalf if the court finds that (s)he:
is 18 years of age or older; and
is suffering from a mental illness; and
is unlikely to survive safely in the community without supervision, based on a clinical determination; and
has a history of lack of compliance with treatment for mental illness which has led to either:
2 hospitalizations for mental illness in the preceding 36 months, or
1 or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the last 48 months; and
is unlikely to voluntarily participate in outpatient treatment that would enable him or her to live safely in the community; and
is in need of AOT in order to avoid a relapse or deterioration which would be likely to result in serious harm to self or others; and
is likely to benefit from AOT.
A court must be satisfied that AOT is the least restrictive alternative before granting an AOT order. If a less restrictive treatment or program exists which could effectively address the person's mental health needs, the court will not grant the petition for an AOT order.
Whom should I contact if I think someone needs assistance through AOT?
Contact your county (or New York City) mental health director. County mental health directors are responsible for operating the county's AOT program and can help you determine whether or not the person meets the criteria for AOT. He or she may also be aware of other available services if AOT is not appropriate for the individual. (Contact county AOT personnel within New York State.)
What is the process to obtain AOT for someone?
The first step is ensuring that the subject of the petition meets the eligibility criteria for AOT. A physician appointed by the director of community services must evaluate the subject, develop a treatment plan which will be proposed to the court as part of the AOT petition package. The physician must be willing and able to testify in court to his/her clinical determination regarding the subject and his/her need for AOT.
A petition for AOT must be filed in the county court or supreme court in the county where the subject is present. Authorized petitioners for AOT include:
any person 18 years of age or older with whom the subject resides;
the parent, spouse, adult sibling, or adult child of the subject;
the director of a hospital in which the subject is hospitalized;
the director of any public or charitable organization, agency or home providing mental health services to the subject or in whose institution the subject resides;
a qualified psychiatrist who is either supervising the treatment of or treating the subject for a mental illness;
a licensed psychologist or a licensed social worker who is treating the subject of a mental illness;
the director of community services, or his or her designee, or the social services official of the city or county in which the subject is present;
a parole or probation officer assigned to supervise the subject.
What specifically needs to be filed with the court to begin the process?
The petition, which is a formal statement of facts demonstrating that the subject meets the criteria for AOT, must be filed in court and accompanied by the affidavit of the examining physician. The affidavit must show that the physician examined the subject within 10 days of the filing of the petition, and that the subject meets the criteria for AOT. If the subject has refused examination, the physician's affidavit must state that attempts at examination were made and that the physician believes the individual meets the AOT criteria. Several other procedural forms must also be filed, and standard court filing fees must be paid at the time of filing. All necessary forms are available through your county mental health department.
Does anything else need to be done?
Once the petition is filed with the court, copies must be served on:
the person who is the subject of the petition;
Mental Hygiene Legal Service, or the subject's private attorney, if he/she has one;
any health care agent appointed by the subject in a health care proxy, if known;
the Program Coordinator appointed by the New York State Office of Mental Health to oversee local AOT programs; and
*the appropriate county (or City of New York) mental health director; and
**the nearest relative of the subject alleged to be mentally ill, if known; and
as many as 3 additional persons, if designated in writing to receive such notice.
*If the subject is presently in your county but will be residing in a different county, it is strongly recommended that the receiving county mental health director and OMH AOT Program Coordinator for that region also be served.
**Service must be effected on the nearest relative regardless of whether or not the subject of the petition has expressed a desire to have his/her family excluded from his/her treatment.
What happens next?
The court is required to set a hearing date that is no more than 3 days after the court receives the petition. (The hearing may be adjourned to an alternate date if the court finds good cause for doing so.) At the hearing, the court will hear testimony of the physician whose affidavit was filed with the petition, and may also consider testimony of the petitioner and the subject of the petition. Other forms of admissible evidence may be considered as well. If the court determines by clear and convincing evidence that the criteria for AOT are met, and a written treatment plan has been filed with the court, an order for assisted outpatient treatment is issued.
To who is the court order directed?
The court order is directed to both the subject of the petition and the local director of the AOT program. The order will require the subject to accept the treatment deemed necessary by the court, and will require the local director to furnish such treatment.
What happens if the person does not comply with the terms of the court order?
If a physician determines that the person has failed to comply with some aspect(s) of the AOT order, and also determines that the person may need involuntary admission to a hospital, the physician may recommend and the county director order the person to be transported to a hospital and retained for up to 72 hours to determine if inpatient care and treatment are necessary. Any refusal of the person to take prescribed medication, or the failure of a test to determine either medication compliance or alcohol or drug use, may be considered by the physician in reaching the clinical determination regarding involuntary admission. Any decision to retain the person beyond the initial 72 hours must be in accordance with the procedures for involuntary admission set forth in Mental Hygiene Law.
How long does the person remain in the AOT program?
The initial court order may be granted for up to 6 months. The order can then be extended for successive periods of up to 1 year each for as long as it is deemed to be necessary and beneficial for the individual. Once an AOT order is expired and not renewed, the individual should continue to receive the same services (s)he was receiving while under the order.
Whom do I contact if I have additional questions about assisted outpatient treatment?
Contact your county (or City of New York) mental health director (DCS) for further information.