ASSISTED OUTPATIENT TREATMENT.
Assisted Outpatient Treatment (AOT) is when the court orders a person to undergo treatment (which includes receiving medication) in order to remain living in the community. Instead of having to “commit” someone to a hospital, AOT provides a less costly and more “humane” option for the state and for caregivers and often results in higher success rates in long-term voluntary compliance.
Each state differs in their criteria and procedures for getting someone help through AOT. Below is information about AOT from my personal experience in the state of Hawaii. If you are looking for more information on AOT in other states, please visit the Treatment Advocacy Center’s website and select your state to learn more.
Assisted Outpatient Treatment in Hawaii = Assisted Community Treatment
The Assisted Community Treatment program (ACT 221) was passed in Hawaii on January 1st, 2014. This program allows any family member, caregiver or private party the right to petition the family court for ACT of a person who is mentally ill. Below is a checklist of activities, links to resources and contact information of the people most knowledgeable about ACT in the state of Hawaii. If you are considering ACT for your loved one, please review the information below and feel free to contact us with any questions or let us know if we can be of any support.
Download the Petitioner’s Summary and Checklist
Review the criteria outlined in the Summary and determine if your loved one meets the criteria for ACT.
If you determine that your loved one does meet all the criteria and ACT is the best option, proceed through the steps outlined in the Checklist.
If you are not sure if ACT is the right program for you and your loved one, read more about Legal Guardianship as an alternate option.
Download the Petition for Assisted Community Treatment
Review the petition and the attached exhibits. Begin collecting the information needed to complete the petition.
Obtain the Help of a Lawyer and Psychiatrist
You will need the help of a family court attorney and psychiatrist to help you complete the petition and present your case in a court hearing. For a list of ACT resources in Hawaii, please see our contact list below.
ACT 221 Petitioner Summary
ACT 221 Petitioner Checklist
Petition for Assisted Community Treatment
Along with the Petitioner’s Summary and Checklist, below are other lessons learned that might be helpful when preparing for ACT:
Consider working with a Case Manager
A case manager could help serve as a liaison between the psychiatrist, the attorney and the person requiring treatment. Caregivers may worry about ruining the relationship with their loved ones if they are seen as the one petitioning and enforcing treatment. A case manager may help caregivers remain "neutral" throughout this process and provide additional support for caregivers. Case management is often covered under health insurance, however, insurance providers often require "consent" from the person who is mentally ill. Since this is often difficult to obtain, private case managers are a good alternative as they do not require consent and can be paid directly by the caregiver. See our contact list below for private case managers in Hawaii.
Be aware that ACT is only 6 months long
If the court accepts your petition and mandates that your loved one receive treatment, this enforcement is only in affect for 6 months. The hope is that your loved one may voluntarily continue treatment after 6 months, however, this may not always be the case. You may petition for an extension of the enforced treatment plan, but this is something you and your family should factor into your decision before petitioning for ACT.
Know that the respondent will be notified of the court hearing, but is not required to attend
Once the petition is submitted, the "respondent" (or the person who is considered mentally ill and in need of treatment) will be notified of the court hearing. The court is legally obligated to physically deliver a notice of the hearing to the respondent. The respondent may attend the court hearing to "defend" themselves, but they are not required to be present in order for the court hearing to proceed.
Understand that the law is new
The new ACT law was passed in Hawaii on Jan 1st, 2014, but the first ACT petition was not submitted until July, 2014. Whenever a new law or program is implemented, there will always be some additional processes and questions that need to be worked out with the first few cases that go through. The court, attorneys, health providers and other mental health advocates are all working hard to make sure the ACT program is implemented appropriately, but it may take some time for some of the "kinks" to be ironed out. This should not stop caregivers from learning more about ACT and petitioning if this is indeed the right decision for you and your loved one. It is just important to understand the reality of the situation in order to have expecations set.
Hawaii Assisted Community Treatment Contact List
Below are a list of resources who are knowledgeable about Assisted Community Treatment in Hawaii and other mental health policies and procedures that may be helpful for you and your loved one.
Diane C. Haar
Hawaii Disability Legal Services, LLC
1188 Bishop Street, Suite 2002
Honolulu, HI 96813
Tel: (808) 536-8074
Fax: (877) 335-2254
David Kupono Fong