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Allegheny County\u2019s adoption of assisted outpatient treatment, or AOT, has some mental health experts worried about coercion and overreliance on medication, but the county says it has safeguards in place and an advisory group in the works.<\/p>\n
On Jan. 1, the county implemented the controversial legal tool for involuntary mental health care in the community \u2014 a decision that was sharply criticized by advocates, including one who called it \u201ccarceral.\u201d County officials, though, said the program\u2019s goal is to decarcerate people with serious mental illness or keep them from entering the criminal legal system. They\u2019re beginning to detail the mechanics of a process that hasn\u2019t previously been used in the state.<\/p>\n
Erin Dalton, director of the county\u2019s Department of Human Services (ACDHS), wrote that \u201cno one will be arrested or jailed for not following their treatment plan\u201d in a Dec. 23 letter to Jennifer Smith, deputy secretary for the state\u2019s Office of Mental Health and Substance Abuse Services.\u00a0<\/p>\n
During a group interview with Pittsburgh\u2019s Public Source, Dalton and other county human services officials explained how the program will minimize contact with law enforcement: Instead of police officers taking a person into custody and transporting them to a health care facility \u2014 which is often what happens to those who are involuntarily hospitalized \u2014 a treatment team will hand-deliver a court summons to a person who is the subject of an AOT petition, or it will be mailed to them.\u00a0<\/p>\n
The county\u2019s adoption of AOT is a victory for the law\u2019s advocates \u2014 including some family members of people with serious mental illness \u2014 who had long pushed for more forceful intervention to help those who resist treatment before they reach a crisis point. But a local researcher, whose team interviewed AOT recipients in large-scale studies, is worried about the impact of more involuntary intervention, even if it takes place in the community. She is skeptical of the county\u2019s contention that AOT can be implemented without leading to arrests of people with serious mental illness.\u00a0<\/p>\n
\u201cIt\u2019s playing with words in a way,\u201d said Nev Jones, an associate professor of social work at the University of Pittsburgh. <\/p>\n
Though AOT is a civil procedure, it has become intertwined with the criminal legal system in other states. In some jurisdictions, people under AOT orders can be arrested if their treatment plan is a condition of parole, she said. And regardless of a person\u2019s criminal legal involvement, courts in Pennsylvania can order an involuntary emergency examination if they don\u2019t adhere to their treatment plan, which may be enforced by police.\u00a0\u00a0\u00a0\u00a0<\/p>\n
Public Source\u2019s series \u201cWhen care is compulsory<\/a>\u201d detailed the debate over AOT and the county\u2019s consideration of this legal tool over the past year. Here\u2019s what county officials and observers are saying now that implementation has started.<\/p>\n What is AOT?<\/p>\n AOT is a legal mechanism for involuntarily treating people with serious mental illness without hospitalizing them.<\/p>\n The law states \u201cany responsible party\u201d 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 \u201ctoothless.\u201d\u00a0<\/p>\n Forty-nine states have AOT statutes on their books. New York was the first and implemented Kendra\u2019s Law<\/a> more than 25 years ago. Massachusetts \u2014 where an AOT bill was recently introduced<\/a> to the state legislature \u2014 and the District of Columbia are the only holdouts<\/a>.\u00a0<\/p>\n Local research and national pressure<\/p>\n In a paper published in July<\/a>, a team of researchers \u2014 including one based at the county\u2019s Department of Human Services \u2014 established a causal link<\/a> between involuntary mental health hospitalizations, or 302s, in Allegheny County and harm a person experiences after they\u2019re discharged, including being charged with a violent crime and dying of suicide or overdose. Human services officials said that harm played a significant role in their decision to implement AOT as an alternative.\u00a0\u00a0<\/p>\n \u201cWe\u2019ve concluded that the risks of doing nothing are higher than the risk of trying this, and [I] think we\u2019ve put a number of safeguards in place\u201d to mitigate the harm that involuntary treatment can cause, Dalton said.\u00a0\u00a0<\/p>\n Jones said she\u2019s \u201cnot surprised\u201d by the county\u2019s decision to implement the law after opting out in previous years. She pointed to a nationwide shift toward strengthening involuntary mental health practices, compounded by an executive order<\/a> issued by President Donald Trump in July that aims to institutionalize unhoused people who have mental illnesses, substance use disorders, or both.\u00a0<\/p>\n \u201cIt\u2019s not only inevitable here, but inevitable across the country at this point\u201d due to the Trump administration\u2019s efforts to \u201cfurther both carrot and stick when it comes to their strategy around AOT,\u201d said Jones, who was awarded a contract by the New York state legislature to co-lead an evaluation of that state\u2019s AOT program. \u201cSo even a county or state that didn\u2019t particularly want to do it at this point in time would be under additional pressure.\u201d\u00a0<\/p>\n How an AOT process would start<\/p>\n Human services officials said the AOT legal process will differ<\/a> from that for involuntary hospitalization.\u00a0<\/p>\n The initial court summons for a hold under Section 302 of the Mental Health Procedures Act<\/a>, applicable when someone poses a danger to themself or others, is often delivered by police, said Michael Rocco, manager of county Information, Referrals and Emergency Services, which authorizes 302 petitions that weren\u2019t filed by a doctor or law enforcement officer. But an official summons for an AOT hearing will be sent by mail and possibly also hand-delivered by a treatment team member, Rocco said during the group interview. \u201cSo it really doesn\u2019t involve law enforcement at all,\u201d he added.\u00a0<\/p>\n Dalton wrote to the state that \u201cpeople\u2019s first engagement with AOT will be a peer, service coordinator or another trusted person\u201d rather than law enforcement.<\/p>\n Collins said that in the case of unhoused people, who may not trust \u201cthe system,\u201d the department will work with its street outreach partners who may have knowledge of the person. Those street outreach workers would be part of a process she called \u201ccase conferencing,\u201d an initial effort \u201cto figure out what\u2019s the best approach for this individual.\u201d\u00a0\u00a0<\/p>\n Jones pointed out that housing placements are built into AOT programs in other jurisdictions. If an unhoused person is guaranteed a housing placement under an AOT order, \u201cthen of course it is going to help them,\u201d said Jones, noting \u201cyou could just as easily prioritize those same people without an AOT order.\u201d\u00a0<\/p>\n An ACDHS spokesperson wrote in an email that the county is assembling a team that will support the AOT process here. That includes:\u00a0<\/p>\n Rocco, whose team is on call 24\/7 to authorize and arrange 302s and would also assist AOT petitioners\u00a0<\/p>\n AOT Coordinator Cindy Simpson, who has 20 years of mental health services experience and will coordinate case conferencing and collaboration among the courts, treatment team members and other stakeholders<\/p>\n An unidentified psychiatrist from Centurion Health<\/a>, a Virginia-based firm that provides correctional health care services across the country and operates the county\u2019s mobile competency restoration team<\/a>, which serves people found not competent to stand trial\u00a0<\/p>\n A \u201cdedicated service coordinator\u201d assigned to each AOT recipient and provided by the Human Services Administration Organization<\/a>, a nonprofit with offices in Carrick and the North Hills that coordinates services for county residents facing court procedures.\u00a0<\/p>\n Concern about arrests remains<\/p>\n If a person ordered to follow an outpatient treatment plan doesn\u2019t comply, the court can conceivably weigh whether they are a danger to themselves and others and then proceed under Section 302. While a 302 petition isn\u2019t a criminal procedure, it often involves contact with law enforcement, who may physically take a person into custody and transport them to a hospital.\u00a0<\/p>\n A New York public defender told Public Source<\/a> last year that those facing an AOT petition while also facing criminal charges are often compelled to comply with their court-ordered treatment plan as part of a plea deal. \u201cThere is a coercive element to that,\u201d said Katherine Bajuk, a senior trial attorney and mental health specialist at New York County Defender Services<\/a>, who represents people facing criminal charges in Manhattan.<\/p>\n Jones said AOT orders in New York can also become a condition of parole. \u201cThe nuance is that, technically, you\u2019re not being arrested because of the AOT violation. You\u2019re technically then being arrested because of the parole violation,\u201d such as failure to comply with treatment, she added.\u00a0\u00a0<\/p>\n Dalton acknowledged that a person facing an AOT order here could face law enforcement in relation to \u201cthings that are happening in escalation,\u201d such as a 911 call made by a petitioner.\u00a0\u00a0\u00a0<\/p>\n An official from the county\u2019s Office of the Public Defender, which will represent those facing AOT petitions, said strict confidentiality laws protecting patients\u2019 mental health information will be the most impactful guardrail during court proceedings. <\/p>\n Information \u201cshould not be fluid between judges and divisions, whether or not someone\u2019s under an AOT order,\u201d said Sarah Linder Marx, \u200b\u200bthe office\u2019s senior deputy director of public outreach and staff development. \u201cUnless the patient expressly waives their confidentiality for a purpose,\u201d such as disclosing their AOT treatment plan to a judge to help their criminal case.<\/p>\n Dalton said Judge Hugh McGough, who serves in the Orphans\u2019 Court division of the county\u2019s Court of Common Pleas, will preside over AOT hearings.<\/p>\n During an interview, McGough emphasized the separation between AOT proceedings and those taking place in a specialty mental health court in the criminal division, which is overseen by Judge Beth Lazarra. He said Orphans\u2019 Court has \u201clined up an excellent team of communicators who will assure\u201d that people facing AOT petitions are heard during the process. We \u201chave a lot of experience listening to and hearing people\u2019s problems, and helping them see their way through those problems with appropriate support.\u201d\u00a0\u00a0\u00a0<\/p>\n AOT and medication<\/p>\n Jones \u2014 who has lived experience of serious mental illness and is a member of the county\u2019s Mental Health\/Intellectual Disability Advisory Board \u2014 said that compelling those under an AOT order to take medication is one of the county\u2019s main goals. That\u2019s typical of most AOT programs across the country, she added.\u00a0<\/p>\n \u201cIt\u2019s a very, very biomedicalized view of recovery, of people\u2019s healing processes,\u201d she said, noting the county is also piloting a program<\/a> to test the efficacy of financially incentivizing people to adhere to psychiatric medication in the form of long-acting injectables.\u00a0<\/p>\n \u201cHow aware are they of the substantial number of people who do not respond to antipsychotics?\u201d Jones asked, explaining that a significant portion of people respond moderately or don\u2019t respond at all to antipsychotic medication. Many also experience intolerable side effects and stop using the drugs.\u00a0<\/p>\n Pim Welle, chief data scientist at ACDHS, emphasized the county\u2019s understanding that medication doesn\u2019t work for everyone or is \u201cnot worth it\u201d due to the side effects. \u201cMedication would never be given in [the] absence of a strong wraparound treatment team that\u2019s trying to engage with the person,\u201d he said. Welle said the treatment team will also work with the person to determine which medication side effects are tolerable and which are not, seeking a balance that stabilizes them and leads to long-term treatment.\u00a0<\/p>\n Study and safeguards<\/p>\n The scientific literature on AOT is mixed. Those who support AOT point to research showing it improves outcomes for people with serious mental illness, while others point to research showing it provides little to no benefit<\/a>.<\/p>\n Officials were motivated to act by \u201cpeople\u2019s calls for something\u201d short of the 302 process, said Dalton. They don\u2019t want \u201cto wait and watch their loved ones decompensate in that way or wait for something more challenging to happen.\u201d\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n Ruth Johnston of Richland started a campaign called AOT for Allegheny County after<\/a> her son, Levi Staver, who has schizophrenia, killed his grandmother while experiencing psychosis in 2013. He\u2019s now in a state prison<\/a> that has a mental health unit \u2014 an outcome that outpatient commitment might have prevented, she said. (Though people with mental illness are disproportionately criminalized<\/a>, research shows they\u2019re more likely<\/a> to be the victim of a violent crime than the perpetrator.)<\/p>\n \u201cI\u2019m thrilled that they are planning to implement [AOT],\u201d said Johnston during an interview in May.\u00a0\u00a0<\/p>\n An official from Light of Life Rescue Mission<\/a>, a Christian charity that contracts with the county to provide emergency shelter to the unhoused, told Public Source via email that he\u2019s pleased the county is using \u201can effective and needed tool in [its] toolbox to serve those who are incapable of rendering self-care.\u00a0<\/p>\n \u201cToo often, suffering neighbors are left in our streets in psychotic crisis, in severe weather, or other life-threatening conditions because they are unable to recognize their need for help,\u201d said Jerrel Gilliam, the nonprofit\u2019s executive director, who worked for more than two years to bring AOT here.\u00a0\u00a0\u00a0\u00a0<\/p>\n The county\u2019s exploration of AOT last year triggered outcry from the law\u2019s critics, including clinical, legal and academic experts who said involuntary care can destroy a patient\u2019s 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. They also pointed out that involuntary treatment disproportionately impacts Black people<\/a> and other people of color, which is borne out in the county\u2019s own 302 data<\/a>. A report published last year<\/a> by New York Lawyers for the Public Interest<\/a> \u2014 which opposes AOT \u2014 found that 38% of current involuntary outpatient commitment orders involved Black people, who make up only about 18% of the state\u2019s population.\u00a0<\/p>\n Reactions to county\u2019s AOT intentions vary<\/p>\n The county\u2019s announcement follows a lengthy stakeholder engagement process, driven in part by a Public Source investigation<\/a> this year of involuntary treatment here and in other jurisdictions. The county also consulted with officials from other jurisdictions with existing AOT programs, including those in California and New York state.<\/p>\n Confirmed AOT advisory group members<\/p>\n Two people with lived experience to be selected by NAMI Keystone PA<\/p>\n Susan Coyle, chief executive officer, Chartiers Center<\/p>\n Betsy Farmer, dean, University of Pittsburgh School of Social Work<\/p>\n Jerrel Gilliam, executive director, Light of Life Rescue Mission<\/p>\n Nev Jones, associate professor, University of Pittsburgh School of Social Work<\/p>\n Autumn Redcross, founding director, Abolitionist Law Center Court Watch Program<\/p>\n Frederick Thieman, former U.S. Attorney of the Western District of Pennsylvania (1993-1997)<\/p>\n Dale Verchick, director of public policy, Disability Rights Pennsylvania<\/p>\n A psychiatrist who has not yet been selected <\/p>\n In a May letter<\/a>, nearly 80 people \u2014 including county residents, Jones and other experts across the country \u2014 urged County Executive Sara Innamorato and County Council members to \u201cchallenge\u201d the Department of Human Services\u2019 intention to implement AOT and demanded \u201crobust transparency and accountability, including third-party evaluation \u2026 and engagement with those directly impacted\u201d if implementation moved forward.\u00a0\u00a0<\/p>\n Dalton told Public Source that starting this month the county will work with a research team based in New York to \u201cdo a more full assessment of our system of care for the seriously mentally ill.\u201d Without going into details about that process, she said her team looks forward to the recommendations that come out of that assessment.\u00a0\u00a0<\/p>\n The county will also establish an advisory group to monitor implementation and review progress through 2026, according to the letter. Confirmed members include Jones and another academic expert, Gilliam of Light of Life, a former U.S. Attorney for the Western District of Pennsylvania, the director of a local court watch program, an unidentified psychiatrist and a disability rights attorney. The group will also include two people with lived experience selected by the National Alliance on Mental Illness (NAMI) Keystone Pennsylvania<\/a> \u2014 the Pittsburgh-based state affiliate of the national parent organization<\/a>.\u00a0<\/p>\n Jones is \u201chappy that there is an advisory board,\u201d calling it an improvement over the \u201czero transparency\u201d in the process so far.\u00a0\u00a0<\/p>\n Gilliam wrote it\u2019s important \u201cthat AOT has clear oversight and accountability to ensure safe and just treatment for all.\u201d\u00a0<\/p>\n The advisory group\u2019s meetings won\u2019t be open to the public due to patient confidentiality laws, Rocco said. As of December, ACDHS had not finalized the group\u2019s meeting schedule or determined what kind of program data would be shared with members. Dalton said she and other officials are considering providing data to the group on a quarterly basis, possibly under non-disclosure agreements.<\/p>\n \u201cSo long as we have those protections in place, we will be an open book on how this is going,\u201d Dalton said.<\/p>\n Venuri Siriwardane is the health and mental health reporter at Pittsburgh\u2019s Public Source. She can be reached at venuri@publicsource.org<\/a>or on Bluesky @venuri.bsky.social<\/a>.<\/p>\n \n\tRELATED STORIES\n<\/p>\n This story was made possible by donations to our independent, nonprofit newsroom. <\/p>\n Can you help us keep going with a gift?<\/p>\n We\u2019re Pittsburgh\u2019s Public Source. Since 2011, we\u2019ve taken pride in serving our community by delivering accurate, timely, and impactful journalism \u2014 without paywalls. We believe that everyone deserves access to information about local decisions and events that affect them.<\/p>\n But it takes a lot of resources to produce this reporting, from compensating our staff, to the technology that brings it to you, to fact-checking every line, and much more. Reader support is crucial to our ability to keep doing this work.<\/p>\n If you learned something new from this story, consider supporting us with a donation today. Your donation helps ensure that everyone in Allegheny County can stay informed about issues that impact their lives. Thank you for your support!<\/p>\n Republish This Story<\/p>\n<\/p>\n
![\"A](\"https:\/\/www.newsbeep.com\/au\/wp-content\/uploads\/2026\/01\/20241021-Winter-homeless-shelter-Pittsburgh-01.jpg\")
Erin Dalton, director of the Allegheny County Department of Human Services, talks to the media about winter shelter plans for people experiencing homelessness on Oct. 21, 2024, in Downtown, as photographed through a chair. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/au\/wp-content\/uploads\/2026\/01\/20250513-AOT-Allegheny-County-Mental-Health-27-1.jpg\")
Allegheny County Department of Human Services staff discuss AOT during an interview at the department\u2019s Downtown headquarters on May 6. From left, Alex Jutca, director of the Office of Analytics, Technology and Planning, Pim Welle, chief data scientist, Michael Rocco, manager of Information, Referral and Emergency Services, Kathryn Collins, chief analytics officer, Jewel Denne, assistant deputy director for the Office of Behavioral Health, and Erin Dalton, director. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n![\"Two](\"https:\/\/www.newsbeep.com\/au\/wp-content\/uploads\/2026\/01\/20240712-Allegheny-County-Jail-Care-13.jpg\")
Janice Kochik, left, and Jordan Woodruff, street outreach nurses at Central Outreach Wellness Center, check on an unhoused person during their rounds on the South Side, on May 8, 2024. The two worked to remove a stuck ring from the person\u2019s swollen finger. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/au\/wp-content\/uploads\/2026\/01\/1000008885-scaled.jpg\")
Judge Hugh McGough poses for a portrait in his courtroom in October 2025. McGough, who serves in the Orphans\u2019 Court division of the Allegheny County Court of Common Pleas, will preside over AOT hearings as the county rolls out its outpatient commitment program.(Photo courtesy of James Piaggio, Allegheny County Bar Association)<\/p>\n![\"Two](\"https:\/\/www.newsbeep.com\/au\/wp-content\/uploads\/2026\/01\/20250513-AOT-Allegheny-County-Mental-Health-02.jpg\")
Nev Jones, left, an associate professor in the School of Social Work at the University of Pittsburgh, and Shannon Pagdon, a Ph.D. student in the program and member of Jones\u2019 research team, stand for a portrait on May 7 in Uptown. Jones is leading a large-scale study of the effects of AOT in New York state with Pagdon and other members of her team. Both have lived experience of serious mental illness and oppose the implementation of AOT in Allegheny County. (Photo by Stephanie Strasburg\/Pittsburgh\u2019s Public Source)<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/au\/wp-content\/uploads\/2026\/01\/20250513-AOT-Allegheny-County-Mental-Health-15.jpg\")
Ruth Johnston points to a childhood photo of her son, Levi Staver, hanging among photos of her parents and family in her Richland Township living room on May 7. Johnston believes AOT could have prevented Staver, who has schizophrenia and autism, from hearing the voices that told him to kill her mother. (Photo by Stephanie Strasburg\/Pittsburgh Public Source)<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/au\/wp-content\/uploads\/2026\/01\/Jerrel-T.-Gilliam.png\")
Jerrel Gilliam, executive director of Light of Life Rescue Mission, has worked to bring AOT to Allegheny County for more than two years. (Courtesy photo)<\/p>\n
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