Myths about Assisted Treatment and Assisted Outpatient Treatment

Some individuals and organizations have raised concern about reforming Assisted Treatment Laws. Much of this is based on misinformation or misunderstanding.  The following document attempts to shed light on the myths surrounding reform of Assisted Treatment Laws.

Myth: Outpatient Assisted Treatment is going to fill hospital wards.

Reality:  Outpatient Assisted Treatment is designed to help people succeed out of the hospital. It helps those with a history of non-compliance induced dangerousness comply with treatment and therefore prevents them from deteriorating to the point where they need hospitalization. The pilot Outpatient Assisted Treatment program at Bellevue cut hospital stays in half.

Myth: Assisted Treatment will empty hospital wards.

Reality: Inpatient hospitalization will still be needed for those incapable of surviving safely in the community.   Assisted Outpatient Treatment facilitates early short-term rehospitalization for those non compliant and likely to become dangerous. 

Myth: Assisted Outpatient Treatment doesn’t work.

Reality: Studies in Iowa, North Carolina, Hawaii and others have definitively proven Assisted Outpatient does work.  Some say one study (of  a Pilot Outpatient Assisted Treatment Project at Bellevue Hospital in NYC) did not show a beneficial effect.  That study was deeply flawed because both the violent and those lacking capacity to make their own decisions--the two groups the program was meant to help--were excluded from the study. In addition those with substance abuse problems were over-represented in the court ordered group, thereby skewing results.  However, contrary to claims, and even with those biases,  the Bellevue study clearly showed following advantages of Assisted Outpatient Treatment:

1. Assisted Outpatient Treatment cut hospital stays in half: from 101 days in the 11 months following discharge for those without court orders to 43 days of hospitalization for those with them. 
2. Of those with substance abuse problems, 66% of the court ordered subjects were able to be rehospitalized versus only 44% of the controls.
3. Controls who were rehospitalized were 2 1/2 times more likely than those in the court ordered group to have to be transferred to the state hospital (i.e. needed long term hospitalization).
4. Those who did not have court ordered treatment spent 14 weeks in the hospital, compared to six weeks for those who did have a court order.
5. When service providers were asked to assess the medication compliance of their patients, 57% of individuals that received medication orders from the court at the time of their hearing were viewed as 75-100% compliant, but only 39% of those with commitment orders that did not include medication compliance conditions were so highly rated. 

Myth: Assisted Outpatient Treatment will bust the budget.

Reality: Assisted Treatment is not expensive because it does not mandate any services that individuals with brain disorders are not already entitled to (example: case management, medications, rehabilitation).  Assisted Outpatient Treatment Orders merely requires the system to facilitate compliance if an individual becomes non-compliant with those services needed to keep them well and the surrounding community safe. Individuals subject to Assisted Treatment Orders rarely violate the orders and hence the interventions are rarely needed.  The data is also clear that the savings in hospital costs, forensic costs and other costs far offsets any incremental cost of Assisted Treatment. In an article in Schizophrenia Bulletin, Dr. Peter Weiden and Dr. Mark Olfson calculated that nationwide, over two years,  the direct costs of rehospitalization attributable to neuroleptic noncompliance is approximately $700 million with $370 million for the first year and $335 million for the second. Assisted Treatment, by increasing compliance can generate savings that could be reinvested in the community.

 Myth: Assisted Outpatient Treatment is Unconstitutional.

Reality: 39 states have Assisted Outpatient Treatment laws. None have been overturned by the Supreme Court.

Myth: Assisted Treatment infringes on civil liberties.

Reality: It is the illness, not the treatment that restricts civil liberties.  Medicines can free individuals from the ‘Bastille of their psychosis” and enable them to  engage in a meaningful exercise of their civil liberties.  Assisted Outpatient Treatment cuts  the need for incarceration, restraints, and involuntary inpatient commitment allowing individuals to retain more of their civil liberties.

Myth: Assisted Treatment requires individuals to take life threatening medications.

Reality:  All the medicines used to control neurobiological disorders have been determined by the FDA to be safe when used according to labeling requirements.  Overdosing on these medicines is difficult. However, all medicines, including those used to treat neurobiological disorders have different efficacy and side effect profiles. The practice of balancing the side effects of the medicines with the likely benefits, is not superseded by Assisted Treatment Legislation.

Myth: If we had more community treatment, we wouldn’t need Assisted Treatment.

Reality: There is no doubt that an improved community based system would cut down on the number of individuals who need assisted interventions.  Assisted Treatment is not an alternative to community treatment, it is a way to see that  community treatments get utilized by those who may lack insight into their illness. 

Myth: Voluntary programs are better than involuntary ones.

Reality: This is true.  Even with Assisted Treatment, individuals would be free to voluntarily participate in services. The only individuals subject to Assisted Treatment would be those whose failure to participate in voluntary services has led to their own dangerousness.

Myth: All “consumers” oppose Assisted Treatment.

Reality: There is a variety of viewpoints within the consumer community. Some consumers oppose Assisted Treatment. Other consumers support Assisted Treatment.  The Treatment Advocacy Center has consumers on it’s board and staff and in its membership who support wider use of it.  A study reported in Psychiatric News, February 7, 1997,  of forcibly treated, discharged psychiatric patients  found that 60 percent retrospectively favored having been treated against their will. (Posted 2/1999)

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