Allegheny County will use a controversial legal tool for involuntary mental health care in the community starting Jan. 1, according to a letter county officials sent Tuesday to the state\u2019s Office of Mental Health and Substance Abuse Services. Called assisted outpatient treatment (AOT), it\u2019s a law that no other Pennsylvania county has been able to successfully implement since state lawmakers voted for it in 2018.\u00a0\u00a0\u00a0\u00a0<\/p>\n
The county developed its AOT plan based on research evidence, advice from local and national experts, and collaboration with partners across county government, wrote Erin Dalton, director of the county\u2019s Department of Human Services, in the letter addressed to Deputy Secretary Jennifer Smith.\u00a0<\/p>\n
Dalton and other human services officials explained the county\u2019s reasoning during an interview Tuesday with Pittsburgh\u2019s Public Source.\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, she said.\u00a0<\/p>\n
Officials were motivated to act by \u201cpeople\u2019s calls for something at a lower threshold of risk than danger to self or others,\u201d Dalton added, referring to the legal requirements for involuntary hospitalization, known as 302 commitments<\/a>. In a paper published in July<\/a>, a team of researchers \u2014 including one based at the Department of Human Services \u2014 established a causal link<\/a> between 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.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n 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<\/p>\n The county will establish an advisory group to monitor implementation and review progress through 2026, according to the letter. Confirmed members include a former U.S. Attorney for the Western District of Pennsylvania, the director of a local court watch program, an unidentified psychiatrist, two academic experts, a disability rights attorney and the director of a major provider of shelter services in the county.\u00a0\u00a0<\/p>\n One member, Nev Jones, an associate professor of social work at the University of Pittsburgh and one of the fiercest critics of the county\u2019s AOT plan, said she\u2019s \u201cnot surprised\u201d by the county\u2019s decision to implement the law. She pointed to a nationwide shift in recent years 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\u00a0\u00a0\u00a0<\/p>\n The 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. Almost exactly a year ago, the county quietly informed the state<\/a> that it would implement the state\u2019s AOT statute<\/a> by Sept. 1. After an inquiry from Public Source in April, officials from the county\u2019s Department of Human Services said the county was \u201cstill in exploration\u201d and hadn\u2019t made a decision yet.\u00a0<\/p>\n At the time, news of the county\u2019s interest in AOT inspired hope among the law\u2019s advocates \u2014 including some family members<\/a> 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.\u00a0<\/p>\n And it triggered outcry from critics of AOT, including clinical 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.\u00a0<\/p>\n The county\u2019s initial Sept. 1 deadline passed as it continued to engage with stakeholders and convened a working group that included officials across county government, including the Court of Common Pleas, the Office of the Public Defender \u2014 which will represent those facing AOT petitions \u2014 and others. It also consulted with officials from other jurisdictions with existing AOT programs, including those in California and New York state, which enacted the nation\u2019s first AOT statute, Kendra\u2019s Law<\/a>, in 1999.<\/p>\n AOT is a legal mechanism for involuntarily treating people with serious mental illness without hospitalizing them. 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 In a May letter<\/a>, nearly 80 county residents and experts from across the country 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\u00a0\u00a0<\/p>\n A draft of the county’s letter to the state, provided by the department to Public Source:<\/p>\n Resources<\/p>\n If you or a loved one are in crisis \u2026<\/p>\n For longer-term support \u2026<\/p>\n Pittsburgh Mercy<\/a> provides a range of behavioral health programs. This isn\u2019t an exhaustive list and many other resources are available in our community.\u00a0<\/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 This <a target=”_blank” href=”https:\/\/www.publicsource.org\/allegheny-county-greenlights-assisted-outpatient-treatment\/”>article<\/a> first appeared on <a target=”_blank” href=”https:\/\/www.publicsource.org”>Pittsburgh’s Public Source<\/a> and is republished here under a <a target=”_blank” href=”https:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/”>Creative Commons Attribution-NoDerivatives 4.0 International License<\/a>.<img src=”https:\/\/i0.wp.com\/www.publicsource.org\/wp-content\/uploads\/2025\/07\/cropped-ps_circle_favicon_blue.png?resize=150%2C150&ssl=1″ style=”width:1em;height:1em;margin-left:10px;”><\/p>\n <img id=”republication-tracker-tool-source” src=”https:\/\/www.publicsource.org\/?republication-pixel=true&post=1327800&ga4=G-CCLXQK5C14″ style=”width:1px;height:1px;”><script> PARSELY = { autotrack: false, onload: function() { PARSELY.beacon.trackPageView({ url: “https:\/\/www.publicsource.org\/allegheny-county-greenlights-assisted-outpatient-treatment\/”, urlref: window.location.href }); } } <\/script> <script id=”parsely-cfg” src=”\/\/cdn.parsely.com\/keys\/publicsource.org\/p.js”><\/script><\/p>\n","protected":false},"excerpt":{"rendered":"by Venuri Siriwardane, Pittsburgh’s Public Source December 23, 2025 Allegheny County will use a controversial legal tool for…\n","protected":false},"author":2,"featured_media":336176,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[44],"tags":[102,1906,6623,56,54,55],"class_list":{"0":"post-336175","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-mental-health","8":"tag-health","9":"tag-mental-health","10":"tag-mentalhealth","11":"tag-uk","12":"tag-united-kingdom","13":"tag-unitedkingdom"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/336175","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/comments?post=336175"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/336175\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media\/336176"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media?parent=336175"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/categories?post=336175"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/tags?post=336175"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nThe National Alliance on Mental Illness [NAMI] Keystone Pennsylvania<\/a> provides peer-led mental health support.
\nThe Squirrel Hill Health Center<\/a> offers free or low-cost behavioral health care to those who are uninsured, including psychiatric evaluations, medication management and therapy. 412-697-7999
\nCentral Outreach Wellness Center <\/a>on the North Side offers low-barrier substance use and mental health care, including counseling and support groups. They specialize in serving LGBTQ+ people, but provide health care to everyone.\u00a0
\nSteel Smiling<\/a> bridges gaps between Black Pittsburghers and mental health supports.
\nThe Jewish Healthcare Foundation\u2019s* Teen Mental Health Collaborative<\/a> provides emotional support, connection and engagement for young people.
\nPersad Center<\/a> offers counseling and other behavioral health services to LGBTQ+ and HIV-positive people.\u00a0\u00a0
\nThe Allegheny County Peer Support Warmline<\/a> can help people with mental health or substance use concerns that haven\u2019t reached a crisis level. Call 1-866-661-9276 between 9 a.m. and 1 a.m. daily.\u00a0<\/p>\n