Training documents on 302 procedures for the Pittsburgh Bureau of Police photographed on Thursday, Sept. 22, 2022, at the City of Pittsburgh Police Training Academy on the North Side.
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When someone’s mental health crisis endangers themselves or others, there are options that don’t involve a call to the police and the risk of incarceration. That’s the aim of laws governing involuntary mental health treatment, which exist in all 50 states and many other countries.
In theory, it’s simple: If a behavioral crisis puts someone in jeopardy, some well-meaning person can start a civil process that leads to treatment.
In practice, involuntary mental health care is fraught with difficult questions about individual rights, due process and interaction with other systems, from employment and child care to (sometimes) criminal court. And some who file a petition for involuntary treatment may not be well-meaning, said legal experts who described how the process can be misused or weaponized to control or punish a loved one.
Pennsylvania in 1976 passed the Mental Health Procedures Act that governs involuntary treatment, and Allegheny County has an established system governing involuntary hospitalization under sections 302 through 305 of that law.
County officials are now exploring assisted outpatient treatment [AOT] — a legal mechanism for involuntary mental health care in the community. The county asserts that involuntary hospitalizations sometimes do more harm than good, so it views court-ordered outpatient mental health care as a possible alternative to so-called 302s. The plan has been criticized by some experts and advocates who say forced outpatient treatment infringes on civil rights and exacerbates lack of trust and disengagement with care.
AOT has not yet been launched in Allegheny County, and doesn’t appear to have been successfully utilized in any Pennsylvania county since it was added to the act in 2018. Other states, including neighboring New York, have developed AOT programs.
Here are the basics of both processes. Below you’ll find resources if you or a loved one are in crisis.
| What the law says | Involuntary Hospitalization | Assisted Outpatient Treatment |
| Who can petition? | Any responsible person can apply. A county administrator or their delegate reviews applications and may issue a warrant for emergency examination; a doctor or police officer can authorize one without a warrant. | Any responsible person can file a petition in the Court of Common Pleas. Requirements include a statement recommending AOT from a psychiatrist or clinical psychologist who examined the person, or the applicant’s written statement — under oath — that the person refused a clinical exam. |
| What are the thresholds for granting? | A severe mental disability based on behavior showing a “clear and present danger” to self and/or others, including lack of voluntary adherence to treatment, overt threats and acts to further threats within the last 30 days. | “Clear and convincing evidence” the person would benefit from AOT must include: a clinical determination that the person is unlikely to survive in the community without supervision; a history of refusing voluntary treatment that resulted in recent involuntary hospitalization or violent behavior; evidence the person is unlikely to commit to a treatment program; and the need to prevent relapse or deterioration. |
| Who can represent the individual? | In most cases, an attorney from the Allegheny County Office of the Public Defender will represent a person facing a 302 petition. The person may choose a private attorney, but that is rare. The court will grant limited continuances to give a person time to find private counsel. | The court would appoint a public defender to represent a person facing an AOT petition. (The county public defender’s office has expressed concerns about its capacity to perform this function if AOT is implemented.) The person can choose a private attorney if they have the means. |
| Who makes the decision? | A doctor who examines a person within two hours of their arrival at a hospital, where treatment starts immediately if they determine the person has a severe mental disability. | A treatment team led by a physician or a clinical psychologist makes the plan, which a judge of the Court of Common Pleas or a court-picked mental health review officer must review. |
| What kinds of treatment can be ordered? | Inpatient psychiatric care, which can include medication, individual or group therapy, social work and case management services. | The state’s AOT statute requires one or more of the following: In-community psychiatric care, assertive community treatment, medication, individual or group therapy, peer support, financial and housing help, substance use treatment and any other service prescribed. |
| Can an order be overturned? | A person can attempt to overturn an inpatient civil commitment order by filing a “petition for review” within 30 days. Orphans’ Court judges hear those petitions, which are typically made by mental health review officers. A 302 order can only be expunged from a person’s record if the hospitalization was not extended under a 303 order. | If AOT hearings are conducted by mental health review officers, the petition for review process would remain the same. Judges may also preside over AOT hearings, which could encourage compliance in lieu of civil penalties, though some experts and advocates worry the “black robe effect” could be traumatizing and discourage voluntary care. |
| How long does an order last? | An involuntary commitment can’t exceed 120 hours (five days) unless a 303 petition is filed for “extended emergency involuntary treatment.” A 303 order can extend for 20 days, a 304 for 90 days, and a 305 for 180 days. | In most cases, the duration of AOT orders will be 90 days (under a 304 petition) or 180 days (under a 305 petition). Courts may renew an AOT order multiple times to facilitate the person’s long-term success in treatment. |
| What are the repercussions for non-compliance? | If a patient’s involuntary treatment is extended under a 303 order, the hospital can force them to take medication against their will. A provider’s second opinion is required to determine if forced medication is necessary. Physical restraints, sedatives and seclusion rooms can be used if a patient becomes violent. | There are no legal repercussions for not complying with an AOT order. State law bars courts from holding a person in contempt if they don’t adhere to treatment. But a court can order an evaluation for involuntary hospitalization. In New York, AOT orders have influenced the patient’s criminal proceedings. |
Source: Pennsylvania General Assembly, prior Public Source reporting
Public Source consulted three attorneys with knowledge of mental health and civil rights law to review this table for factual accuracy.
If you or a loved one are in crisis …
- Anyone in crisis can call 988 or otherwise reach out to the 988 Lifeline.
- Allegheny County has posted a list of mental health crisis resources and a directory of mental health and drug and alcohol services.
- resolve Crisis Services offers 24/7 response, including in-person mobile crisis teams. 1-888-796-8226 (1-888-7-YOU-CAN) or via walk-in at 333 North Braddock Ave.
- UPMC Western Psychiatric Hospital treats mental and behavioral health conditions. 412-624-1000
- Allegheny County Information Referral and Emergency Services can assist with transportation to a facility for an evaluation. 412-350-4456 or OBHInformationRequest@AlleghenyCounty.us
- Trans Lifeline offers emotional and financial support to trans people in crisis. Peer-support: 877-565-8860. Operating hours are listed here.
- Women’s Center and Shelter of Greater Pittsburgh operates a 24/7 hotline for domestic violence survivors. Its services include emergency shelter, safety planning, individual therapy, group support and substance use recovery counseling. 412-687-8005
- Disability Rights Pennsylvania provides Pennsylvanians with disabilities — including psychiatric disabilities — with legal advice and information, advocacy and referrals to resources. 800-692-7443
- Bridge to the Mountains is a street outreach group providing essential supplies to housing-insecure people, harm reduction and overdose prevention services and referrals for substance use treatment and other services. 412-699-0462
- Prevention Point Pittsburgh offers substance use treatment and harm reduction services at mobile sites throughout the city. Find locations and hours here. Call 412-247-3404 to confirm appointment availability.
For longer-term support …
- Pittsburgh Mercy provides a range of behavioral health programs.
- The National Alliance on Mental Illness [NAMI] Keystone Pennsylvania provides peer-led mental health support.
- The Squirrel Hill Health Center offers free or low-cost behavioral health care to those who are uninsured, including psychiatric evaluations, medication management and therapy. 412-697-7999.
- Central Outreach Wellness Center on the North Side offers low-barrier substance use and mental health care, including counseling and support groups. They specialize in serving LGBTQ+ people, but provide health care to everyone.
- Steel Smiling bridges gaps between Black Pittsburghers and mental health supports.
- The Jewish Healthcare Foundation’s* Teen Mental Health Collaborative provides emotional support, connection and engagement for young people.
- Persad Center offers counseling and other behavioral health services to LGBTQ+ and HIV-positive people.
- The Allegheny County Peer Support Warmline can help people with mental health or substance use concerns that haven’t reached a crisis level. Call 1-866-661-9276 between 9 a.m. and 1 a.m. daily.
This isn’t an exhaustive list and many other resources are available in our community.
Venuri Siriwardane is Pittsburgh Public Source’s health and mental health reporter. She can be reached at venuri@publicsource.org or on Bluesky @venuri.bsky.social.
Rich Lord is the managing editor at Pittsburgh Public Source and can be reached at rich@publicsource.org.
*The Jewish Healthcare Foundation has contributed funding to PublicSource’s health care reporting.
This article first appeared on Pittsburgh’s Public Source and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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