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’s Office of Mental Health and Substance Abuse Services. Called assisted outpatient treatment (AOT), it’s a law that no other Pennsylvania county has been able to successfully implement since state lawmakers voted for it in 2018.
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’s Department of Human Services, in the letter addressed to Deputy Secretary Jennifer Smith.
Dalton and other human services officials explained the county’s reasoning during an interview Tuesday with Pittsburgh’s Public Source.
“We’ve concluded that the risks of doing nothing are higher than the risk of trying this, and (I) think we’ve put a number of safeguards in place” to mitigate the harm that involuntary treatment can cause, she said.
Officials were motivated to act by “people’s calls for something at a lower threshold of risk than danger to self or others,” Dalton added, referring to the legal requirements for involuntary hospitalization, known as 302 commitments. In a paper published in July, a team of researchers — including one based at the Department of Human Services — established a causal link between 302s in Allegheny County and harm a person experiences after they’re discharged, including being charged with a violent crime and dying of suicide or overdose.
They don’t want “to wait and watch their loved ones decompensate in that way or wait for something more challenging to happen.”
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.
One member, Nev Jones, an associate professor of social work at the University of Pittsburgh and one of the fiercest critics of the county’s AOT plan, said she’s “not surprised” by the county’s 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 issued by President Donald Trump in July that aims to institutionalize unhoused people who have mental illnesses, substance use disorders, or both.