Outpatient commitment

Outpatient commitment—also called Assisted Outpatient Treatment (AOT) or a Community Treatment Order (CTO)—refers to a civil court procedure wherein a judge orders an individual diagnosed with a severe mental disorder who is experiencing a psychiatric crisis that requires intervention to adhere to an outpatient treatment plan designed to prevent further deterioration that is harmful to themselves or others. Outpatient commitment—also called Assisted Outpatient Treatment (AOT) or a Community Treatment Order (CTO)—refers to a civil court procedure wherein a judge orders an individual diagnosed with a severe mental disorder who is experiencing a psychiatric crisis that requires intervention to adhere to an outpatient treatment plan designed to prevent further deterioration that is harmful to themselves or others. This form of involuntary treatment is distinct from involuntary commitment in that the individual subject to the court order continues to live in their home community rather than being detained in hospital or incarcerated. The individual may be subject to rapid recall to hospital, including medication over objection, if the conditions of the order are broken, and the person's mental health deteriorates. This generally means taking psychiatric medication as directed and may also include attending appointments with a mental health professional, and sometimes even not to take non-prescribed illicit drugs and not associate with certain people or in certain places deemed to have been linked to a deterioration in mental health in that individual. Criteria for outpatient commitment are established by law, which vary among nations and, in the U.S. and Canada, among states or provinces. Some jurisdictions require court hearings and others require that treating psychiatrists comply with a set of requirements before compulsory treatment is instituted. When a court process is not required, there is usually a form of appeal to the courts or appeal to or scrutiny by tribunals set up for that purpose. Community treatment laws have generally followed the worldwide trend of community treatment. See mental health law for details of countries which do not have laws that regulate compulsory treatment. In the United States the term 'assisted outpatient treatment' (AOT) is often used and refers to a process whereby a judge orders a qualifying person with symptoms of severe untreated mental illness to adhere to a mental health treatment plan while living in the community. The plan typically includes medication and may include other forms of treatment as well. Australia, Canada, England, and New Zealand use the term 'community treatment order' (CTO). The UN Convention on the Rights of Persons with Disabilities, General comment No. 1 (2014) on Article 12: Equal recognition before the law, specifies that forced treatment, among other discriminatory practices must be abolished in order to ensure that full legal capacity is restored to persons with disabilities on an equal basis with others. Discussions of 'outpatient commitment' began in the psychiatry community in the 1980s following deinstitutionalization, a trend that led to the widespread closure of public psychiatric hospitals and resulted in the discharge of large numbers of people with mental illness to the community. Denmark introduced outpatient commitment in 2010 with the Mental Health Act (Danish: Lov om anvendelse af tvang i psykiatrien). In Germany, as of 2014, only former forensic psychiatry patients may be placed under community treatment orders. Legislation to allow for wider use of CTOs was considered in 2003–2004, but it was ultimately rejected by the Bundestag.