Valasek Chad J, Nelson Kris L, Fettes Danielle L, Sommerfeld David H
Department of Psychiatry, University of California San Diego, La Jolla.
Psychiatr Serv. 2025 May 1;76(5):469-478. doi: 10.1176/appi.ps.20240190. Epub 2025 Jan 10.
The use of court-ordered mental health treatment through programs such as assisted outpatient treatment (AOT) carries substantial ramifications for the welfare of individuals with serious mental health conditions.
In this review, the authors used a narrative methodology and performed an interpretive synthesis of existing U.S.-based literature (2008-2023) on AOT implementation and outcomes.
The search yielded 21 peer-reviewed articles published between 2009 and 2022 that assessed various aspects and outcomes of AOT. Although many of these studies generally supported the use of AOT, most used a limited data set (i.e., AOT program data from New York or Ohio between 1999 and 2007). Much of the latest research on AOT did not include attention to possible mechanisms to explain observed outcomes. The emerging literature suggests that increased outreach and less coercive tactics may lead to better outpatient treatment outcomes. However, more research, especially from the point of view of individuals enrolled in AOT programs, is needed.
The authors strongly recommend that research into these interventions be broadened and include more geographic locations. A greater emphasis should be placed on identifying potential disparities, developing a better understanding of AOT-specific mechanisms of change, and continuing efforts to identify and use high-quality comparison groups.
