Current Psychiatry Reports

, 20:112 | Cite as

Update on Assisted Outpatient Treatment

  • Stephanie N. Cripps
  • Marvin S. SwartzEmail author
Public Policy and Public Health (G Norquist, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Public Policy and Public Health


Purpose of Review

Assisted outpatient treatment (AOT) is an outpatient court-ordered treatment for people with severe mental illness (SMI) whose care needs are often unmet in the community due, in part, to treatment non-adherence. AOT is controversial, and the goal of this review is to provide an update on recent research, the status of AOT in the United States, and future directions for research and implementation.

Recent Findings

Several recent studies have demonstrated that it is not just a lack of access to appropriately intensive care that prevents some individuals with SMI from engaging in and benefiting from treatment and that AOT can improve engagement and patient outcomes over and above the provision of care.


The future of AOT in the United States is still somewhat uncertain and will largely depend on the effectiveness and sustainability of the SAMHSA AOT grant programs. Future research efforts should investigate the conditions under which and for whom AOT can be most effective, to help avoid poor outcomes for this vulnerable population.


Assisted outpatient treatment Involuntary outpatient commitment Community treatment orders 


Compliance with Ethical Standards

Conflict of Interest

Stephanie N. Cripps declares no conflict of interest.

Marvin S. Swartz has received a grant from RTI and personal fees from PRA Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Binder R. Assisted outpatient treatment: APA’s position statement. Psychiatric News. 2016:29.
  2. 2.
    Swartz MS, Bhattacharya S, Robertson AG, Swanson JW. Involuntary outpatient commitment and the elusive pursuit of violence prevention. Can J Psychiatr. 2017;62(2):102–8.CrossRefGoogle Scholar
  3. 3.
    Swanson JW, Swartz MS. Why the evidence for outpatient commitment is good enough. Psychiatr Serv. 2014;65(6):808–11.CrossRefPubMedGoogle Scholar
  4. 4.
    Burns T, Rugkasa J, Molodynski A, Dawson J, Yeeles K, Vazquez-Montes M, et al. Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial. Lancet. 2013;381(9878):1627–33.CrossRefPubMedGoogle Scholar
  5. 5.
    Steadman HJ, Gounis K, Dennis D, Hopper K, Roche B, Swartz M, et al. Assessing the New York City involuntary outpatient commitment pilot program. Psychiatr Serv. 2001;52(3):330–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Swartz MS, Swanson JW, Wagner HR, Burns BJ, Hiday VA, Borum R. Can involuntary outpatient commitment reduce hospital recidivism?: findings from a randomized trial with severely mentally ill individuals. Am J Psychiatry. 1999;156(12):1968–75.PubMedGoogle Scholar
  7. 7.
    Rugkasa J. Effectiveness of community treatment orders: the international evidence. Can J Psychiatr. 2016;61(1):15–24.CrossRefGoogle Scholar
  8. 8.
    Wolff N. Using randomized controlled trials to evaluate socially complex services: problems, challenges and recommendations. J Ment Health Policy Econ. 2000;3(2):97–109.CrossRefPubMedGoogle Scholar
  9. 9.
    Segal AG, Sisti DA. “Restricted community members”: research protections and opportunities for individuals committed to assisted outpatient treatment. Psychiatr Serv. 2017;68(2):189–91.CrossRefPubMedGoogle Scholar
  10. 10.
    • O’Reilly R, Vingilis E. Are randomized control trials the best method to assess the effectiveness of community treatment orders? Admin Pol Ment Health. 2018;45(4):565–74 Propose several alternative models for research design using theory-based approaches which could provide a more nuanced understanding of an AOT program. CrossRefGoogle Scholar
  11. 11.
    • Schneeberger AR, Huber CG, Lang UE, Muenzenmaier KH, Castille D, Jaeger M, et al. Effects of assisted outpatient treatment and health care services on psychotic symptoms. Soc Sci Med 2017;175:152–60. Results suggest the positive effect AOT has on psychotic symptoms is related to the availability of mental healthcare service use, further suggesting that AOT is more effective with greater use of and engagement with intensive services. CrossRefGoogle Scholar
  12. 12.
    • O’Reilly R, Corring D, Richard J, Plyley C, Pallaveshi L. Do intensive services obviate the need for CTOs? Int J Law Psychiatry 2016;47:74–8. Findings support the idea that within the SMI population, there are groups of people who may require mandated supervision, such as AOT, to adhere to treatment. Google Scholar
  13. 13.
    • Segal SP, Hayes SL, Rimes L. The utility of outpatient commitment: acute medical care access and protecting health. Soc Psychiatry Psychiatr Epidemiol. 2018;53(6):597–606 Findings suggest that accessibility of care is not the sole reason why persons with SMI fail to receive adequate physical health care. CrossRefPubMedGoogle Scholar
  14. 14.
    • Meldrum ML, Kelly EL, Calderon R, Brekke JS, Braslow JT. Implementation status of assisted outpatient treatment programs: a national survey. Psychiatr Serv. 2016;67(6):630–5 Describes the actual operation of AOT programs in practice in the United States in 2014. CrossRefPubMedGoogle Scholar
  15. 15.
    SAMHSA awards up to $54 million for the Assisted Outpatient Treatment Program to help address the need of people who have experienced serious mental illness [press release]. 9 September 2016.
  16. 16.
    Protecting Access to Medicare Act of 2014, Pub. L. No. 113-93 Stat. 1040 (1 April 2014).Google Scholar
  17. 17.
    Assisted Outpatient Treatment Grant Program for Individuals with Serious Mental Illness [grant announcement]. 18 April 2016.
  18. 18.
    Swartz MS, Hoge SK, Pinals DA, Lee E, Lee L, Sidor M, et al. Resource document on involuntary outpatient commitment and related programs of assisted outpatient treatment. APA resource document. American Psychiatric Association. October 2015. <>.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamUSA

Personalised recommendations