INTRODUCTION
Involuntary outpatient placement (IOP), also know as “assisted outpatient treatment” (AOT), was developed to provide services to individuals while they reside in the community. IOP was designed to help individuals with a history of non-compliance induced dangerous behavior comply with treatment; thus preventing deterioration and hospitalization.
Definition
A common definition of involuntary outpatient treatment (IOP) is (see Box):
Definition of Involuntary Outpatient Placement (IOP) “. . . categories of outpatient treatment which have been ordered by a court for certain individuals found by the court to be in need of such treatment . . . an assisted outpatient is a person under court order receiving assisted outpatient treatment . . . including a variety of services, such as therapy, case management, and educational and vocational programming” (Lawson, 2004:p. 1).
MAJOR COMPONENTS & SUB-COMPONENTS OF
INVOLUNTARY OUTPATIENT PLACEMENT
Involuntary Outpatient PlacementMajor Components & Sub-Components Checklist
Current Practice Yes No
1. ACT, Intensive Case Management, or other case management
N/A*
2. Medication Evaluation and Management N/A*
3. Supportive Housing N/A*
4. Supportive Education/Supportive Employment N/A*
5. Psychotherapy (individual, family, group, rehabilitation, etc.)
N/A*
6. Consumer Self-Help Initiatives N/A*
* None of these practices are currently in place as this legislation will not be implemented until January 1, 2005
Components of AOT which are discussed in additional sections of this report, include but are not limited to:
y ACT, Intensive Case Management, and other forms of case management y Medication Evaluation and Management
y Supportive Housing
y Supportive Education/Employment
y Therapy (individual, family, group, rehabilitation, etc.) y Consumer Self-Help Initiatives
Ten of twelve studies on AOT found the following benefits: reduced hospital stays, violence and arrests, and improved chances of recovery for individuals with SPMI. In a study from North Carolina, considered to be one of the most comprehensive studies to date, long-term AOT reduced hospital admissions by 57% and length of hospital stay by 20 days, as compared to individuals not utilizing AOT. Among individuals with psychotic disorders, AOT proved to be even more effective reducing hospital readmissions 72% and stays by an average of 28 days (1999, Swartz, M.S.;
Swanson, J.W.; Wagner, H.R.; Burns, B.J.; Hiday, V.A.; & Borum, R., p. 1971). While these statistics are impressive, it is important to note that the two studies not finding the above benefits cited the reasons being hospital staff felt outpatient clinic staff were not vigorously enforcing the law; lack of funding for resources, i.e. transportation; and an inability to draw conclusions on small sample size (Treatment Advocacy Center, 2004 & Bursten, 1986).
CURRENT LOCAL PRACTICE
During Florida’s 2004 legislative session, senate bill 0700 was passed amending the Baker Act, and created Involuntary Outpatient Placement (IOP), which is scheduled to go into effect January 1, 2005. It is unknown what impact, if any, this and other recent legislation will have on Orange County’s community mental health and substance abuse system. Therefore, we can only report at this time what this bill states: “involuntary placement means either involuntary outpatient treatment pursuant to s. 394.4655 or involuntary inpatient treatment pursuant to s. 394.467.” In an effort to better understand this definition, the specific criteria for Florida Statute 394.4655 are outlined below (pp. 23-24):
y the person must be 18 years of age or older; y the person is suffering from a mental illness;
y the person is unlikely to survive safely in the community without supervision, based on a clinical determination;
y the patient has a history of lack of compliance with treatment for mental illness; y the person has:
3 at least twice within the last 36 months been involuntarily admitted to a receiving or treatment facility as defined in s. 394.455, or has received mental health services in a forensic or correctional facility. The 36-month period does not include any period during which the person was admitted or incarcerated; or
3 engaged in one or more acts of serious violent behavior toward self or others, or attempts at serious bodily harm to himself or herself or others, within the preceding 36 months;
y the person is, as a result of his or her mental illness, unlikely to voluntarily participate in the recommended treatment plan and either he or she has refused voluntary placement for treatment or he or she is unable to determine for himself or herself whether placement is necessary;
y in view of the person’s treatment history and current behavior, the person is in need of involuntary outpatient placement in order to prevent relapse or deterioration that would be likely to result in serious bodily harm to himself or herself or others, or a substantial harm to his or her well-being as set forth in s. 394.463 (1);
y it is likely that the person will likely benefit from involuntary outpatient placement; and y all available less restrictive alternatives that would offer an opportunity for improvement of
his or her condition have been judged to be inappropriate or unavailable.
SECTION SUMMARY
Involuntary outpatient placement does not currently exist in Orange County, but has been authorized by the Florida Legislature to begin on January 1, 2005.