Allegheny County officials announced their plan to initiate assisted outpatient treatment (AOT) services beginning January 1, marking the first Pennsylvania county to enact this state law passed in 2018. The county’s Department of Human Services developed the program following a comprehensive analysis of research evidence, advice from both local and national experts, and collaboration among various county government partners.
Erin Dalton, director of the Department of Human Services, conveyed the plan in a letter addressed to Jennifer Smith, Deputy Secretary of the state Office of Mental Health and Substance Abuse Services. Dalton and other human services representatives elaborated on the reasoning behind adopting AOT in a Tuesday interview with Pittsburgh's Public Source.
Dalton expressed a belief that the inherent risks of maintaining the status quo surpass those introduced by implementing AOT. She emphasized that multiple safeguards have been integrated to minimize potential harm related to involuntary treatment. Officials were driven by frequent community calls for intervention options with lower thresholds than the current requirement of imminent danger to self or others, which triggers involuntary hospitalization or "302 commitments."
A research paper published in July, authored in part by personnel from the Department of Human Services, highlighted a direct correlation between 302 commitments and adverse outcomes following discharge. These outcomes include violent crime charges, suicide, and overdose deaths among affected individuals.
Community members urged action not to endure the deterioration of loved ones or await more severe developments. To oversee the program, the county intends to assemble an advisory group tasked with monitoring implementation progress through 2026. The group’s confirmed members include a former federal prosecutor, a local court watch director, academic experts, a disability rights attorney, a psychiatrist, and the head of a major shelter provider.
Among the advisory members, Nev Jones, an associate professor of social work at the University of Pittsburgh, who has been a vocal critic of the AOT plan, acknowledged her expectation of the county's decision. She noted a broader trend across the U.S. toward reinforcing involuntary mental health measures, alongside a federal executive order from July aimed at institutionalizing homeless individuals grappling with mental health and substance use issues.
The county's move follows an extensive stakeholder engagement effort and public scrutiny, partially prompted by investigative reports examining involuntary treatment practices locally and nationally. Approximately one year prior, Allegheny County quietly notified state officials of its intent to activate the AOT statute by September 1. However, following inquiries earlier this year, county officials indicated they were still evaluating the decision.
The prospect of implementing AOT generated optimism among law advocates and family members seeking more assertive pre-crisis interventions for people with serious mental illness, while simultaneously provoking opposition from clinicians, researchers, and civil rights advocates. Critics warn that coercive treatment may erode patients' trust in public mental health services and raise significant civil liberties issues.
Despite missing the initial September deadline, the county continued engagement through working groups comprising court officials, the public defender’s office, and other stakeholders. The department also consulted with counterparts in California and New York, where similar AOT laws, such as New York’s Kendra’s Law, have been operational for decades.
Assisted outpatient treatment offers a legal pathway for mandating community-based treatment for individuals with serious mental illness without necessitating hospitalization. Initiation begins with a petition from any responsible party and proceeds through a civil court hearing, which can result in a judge ordering the individual to adhere to treatment plans that typically include psychiatric medication and can incorporate therapy and other supportive services. However, enforcement limitations exist since courts cannot penalize noncompliance with treatment orders, a point critics highlight as a weakness of the statute.
In May, a coalition of nearly 80 county residents and national experts advocated for rejecting the Department of Human Services’ AOT implementation plans. They called for enhanced transparency, accountability, and independent evaluation, especially involving individuals directly affected, should the program proceed.