After lengthy study and contentious debate, officials say assisted outpatient treatment, or AOT, will be an alternative to involuntary hospitalization. The county says no one will be jailed or arrested for failure to stick with treatment, and an advisory group will monitor AOT’s use.
When care is compulsory
Allegheny County’s 302s, the push for AOT and the debate over involuntary treatment
The county developed its AOT plan based on research evidence, advice from local and national experts, and collaboration with partners across county government, wrote Erin Dalton, director of the county’s Department of Human Services, in the letter addressed to Deputy Secretary Jennifer Smith.
Dalton and other human services officials explained the county’s reasoning during an interview Tuesday with Pittsburgh’s Public Source.
“We’ve concluded that the risks of doing nothing are higher than the risk of trying this, and [I] think we’ve put a number of safeguards in place” to mitigate the harm that involuntary treatment can cause, she said.
Officials were motivated to act by “people’s calls for something at a lower threshold of risk than danger to self or others,” Dalton added, referring to the legal requirements for involuntary hospitalization, known as 302 commitments. In a paper published in July, a team of researchers — including one based at the Department of Human Services — established a causal link between 302s in Allegheny County and harm a person experiences after they’re discharged, including being charged with a violent crime and dying of suicide or overdose.
They don’t want “to wait and watch their loved ones decompensate in that way or wait for something more challenging to happen.”
The county will establish an advisory group to monitor implementation and review progress through 2026, according to the letter. Confirmed members include a former U.S. Attorney for the Western District of Pennsylvania, the director of a local court watch program, an unidentified psychiatrist, two academic experts, a disability rights attorney and the director of a major provider of shelter services in the county.
One member, Nev Jones, an associate professor of social work at the University of Pittsburgh and one of the fiercest critics of the county’s AOT plan, said she’s “not surprised” by the county’s decision to implement the law. She pointed to a nationwide shift in recent years toward strengthening involuntary mental health practices, compounded by an executive order issued by President Donald Trump in July that aims to institutionalize unhoused people who have mental illnesses, substance use disorders, or both.
The announcement follows a lengthy stakeholder engagement process, driven in part by a Public Source investigation this year of involuntary treatment here and in other jurisdictions. Almost exactly a year ago, the county quietly informed the state that it would implement the state’s AOT statute by Sept. 1. After an inquiry from Public Source in April, officials from the county’s Department of Human Services said the county was “still in exploration” and hadn’t made a decision yet.
At the time, news of the county’s interest in AOT inspired hope among the law’s advocates — including some family members of people with serious mental illness — who had long pushed for more forceful intervention to help those who resist treatment before they reach a crisis point.
And it triggered outcry from critics of AOT, including clinical and academic experts who said involuntary care can destroy a patient’s trust in the public mental health system and has serious implications for the civil rights and individual autonomy of some of the most vulnerable people in the county.
The county’s initial Sept. 1 deadline passed as it continued to engage with stakeholders and convened a working group that included officials across county government, including the Court of Common Pleas, the Office of the Public Defender — which will represent those facing AOT petitions — and others. It also consulted with officials from other jurisdictions with existing AOT programs, including those in California and New York state, which enacted the nation’s first AOT statute, Kendra’s Law, in 1999.
AOT is a legal mechanism for involuntarily treating people with serious mental illness without hospitalizing them. The law states “any responsible party” can file an AOT petition, which starts a civil court procedure. During a hearing, a judge may order a person to undergo treatment in the community, which typically includes psychiatric medication, but can also include therapy and other wraparound services. The statute bars courts from holding someone in contempt or issuing penalties for not following their treatment plan, which makes the law difficult to enforce. Some experts called it “toothless.”
In a May letter, nearly 80 county residents and experts from across the country urged County Executive Sara Innamorato and County Council members to “challenge” the Department of Human Services’ intention to implement AOT and demanded “robust transparency and accountability, including third-party evaluation … and engagement with those directly impacted” if implementation moved forward.
A draft of the county’s letter to the state, provided by the department to Public Source:
Resources
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.
- 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.
