By Leah Ida Harris<\/p>\n
This article was originally published by Truthout<\/a><\/p>\n Massachusetts is now one of only two states that don\u2019t use specialized courts to mandate forced psychiatric treatment.<\/p>\n<\/p>\n On November 18, 2025, Massachusetts advocates gathered for hours at the State House<\/a> as they have, year after year, to beat back yet another legislative proposal for involuntary outpatient commitment<\/a>, or IOC. Involuntary outpatient commitment laws create a layer of specialized courts<\/a> that use the so-called \u201cBlack Robe Effect<\/a>,\u201d which uses a judge\u2019s authority to compel people with diagnoses of \u201csevere mental illness\u201d to accept mental health and\/or substance use intervention against their will \u2014 in the form of psychotropic medication, drug testing, and invasive and time-consuming requirements.<\/p>\n While the specifics vary state by state, there are consequences for noncompliance. If the person does not follow their court-ordered treatment plan, they could be snatched by the cops, transported to a locked psychiatric facility for evaluation, and subject to ongoing state surveillance<\/a>. It\u2019s also not entirely clear where the offramp lies, as treatment orders can theoretically be renewed ad infinitum at a judge\u2019s discretion.<\/p>\n Starting in 1999 in New York<\/a>, the conservative think tank Treatment Advocacy Center rebranded involuntary outpatient commitment and began using the language of \u201cassisted outpatient treatment (AOT),\u201d a euphemized term erasing any reference to coercion. Along with the Treatment Advocacy Center, a coalition of police, psychiatrists, social workers, and family caregivers have pushed the laws through in 48 states and the District of Columbia. Massachusetts and Connecticut remain the only holdouts. Fern Fairchild, director of Massachusetts\u2019 Wild Ivy Social Justice Network<\/a>, part of the Wildflower Alliance<\/a>, who has organized against forced treatment in both states, told Truthout that she attributes the lack of such laws in those two states, in large part, to \u201cvery strong survivors\u2019 movements<\/a>\u201d aligned with disability rights and legal advocates.<\/p>\n As Bowen Cho wrote in a 2024 report<\/a> for the Disability Rights Education and Defense Fund, entitled Equity for Whom? How Private Equity and the Punishment Bureaucracy Exploit Disabled People, \u201cCarceral industries and their logics shapeshift and expand in response to public attention, often replacing one egregious system for another and calling it reform.\u201d<\/p>\n Involuntary outpatient commitment is a perfect example of this shapeshifting. In Massachusetts, the law\u2019s framing has been \u201cforcewashed\u201d \u2014 in other words, the carceral logic<\/a> of it has been obscured beneath a language of care. The 2017-2018 version<\/a>, entitled \u201cAn act establishing court ordered mental health assisted outpatient treatment\u201d was further euphemized in 2021-2022 to refer to \u201cassisted outpatient therapy,\u201d with no mention of court orders. H.1801<\/a>\/S.1115<\/a>, the bills currently before the Massachusetts legislature, now refer simply to a \u201ccontinuum of care for severe mental illness,\u201d and use the language of \u201ccritical community mental health services,\u201d without mentioning \u201cassisted outpatient treatment.\u201d<\/p>\n \u201cThe mainstream view of AOT is generally that this mechanism is a \u2018less restrictive\u2019 alternative to inpatient hospitalization and means of connecting folks to care, who may be unhoused or \u2018abandoned to the streets,\u2019\u201d Dr. Nev Jones, associate professor in the School of Social Work at the University of Pittsburgh, told Truthout via email. Jones is actively studying<\/a> the implementation and impacts<\/a> of AOT across multiple U.S. states.<\/p>\n The reality is often quite different from the hype. \u201cOnce on AOT orders, many individuals will remain unhoused if that\u2019s where they\u2019ve started \u2014 very few states guarantee housing to individuals on AOT,\u201d Jones wrote.<\/p>\n A \u201cSystemically Racist\u201d Law<\/p>\n Involuntary outpatient commitment has often been likened to probation<\/a>, and as Fairchild testified, is \u201csystemically racist.\u201d Clinicians diagnose Black people with schizophrenia<\/a>, psychosis<\/a> spectrum disorders, and other \u201csevere mental illnesses\u201d that make them eligible for coercive programs like involuntary outpatient commitment in far greater numbers than their white counterparts. This injustice persists due to clinicians\u2019 documented racial bias<\/a> and the white supremacist, colonial<\/a> roots of the psychiatric profession<\/a> itself.<\/p>\n Everywhere the involuntary outpatient commitment program has been implemented and studied, Black and Brown people are overrepresented. As legal scholar Victoria Rodr\u00edguez-Rold\u00e1n wrote<\/a> of the racially disparate outcomes of New York State\u2019s outpatient commitment law, \u201cthe conclusion that any overrepresentation of minorities in the AOT program is harmful is inescapable.\u201d<\/p>\n Fairchild\u2019s testimony noted that involuntary outpatient commitment \u201cwould also likely impact other communities, such as trans people and immigrants who are also disproportionately diagnosed and are being targeted right now by the Trump administration.\u201d<\/p>\n The 2025-2026 bill text<\/a> further violates privacy and autonomy by redefining who can initiate a petition for court-ordered psychiatric intervention \u2014 expanding beyond the already massive net of spouses, parents and relatives, intimate partners, and legal guardians, to include \u201cany responsible adult or individual partner in a substantive relationship.\u201d Fairchild noted<\/a> in her written testimony that this wide net could easily be misused \u201cin furtherance of domestic abuse, giving these individuals another level of power to wield over victims.\u201d<\/p>\n In the new bill, parole and probation officers are also granted the power to petition for court-ordered treatment. \u201cThe probation and parole systems are particularly punitive, regularly reincarcerating people for minor violations,\u201d Fairchild testified. \u201cInvolving these systems and actors within them in IOC order petitions would likely result in even more psychiatric incarcerations resulting from violations of the conditions set forth in an IOC order.\u201d<\/p>\n Eligibility criteria have also been expanded, broadening the justification for psychiatric force. This bill expands the definition of \u201cgravely disabled,\u201d a \u201cvague term that could apply to anyone a mental health provider believes is not taking adequate care of themselves, including people who are unhoused,\u201d according to written testimony<\/a> by the Mental Health Legal Advisors Committee. Grave disability now includes people who \u201cdemonstrate psychosis\u201d \u2014 and again, given the demonstrated racial bias in such assessments, this designation is deeply problematic.<\/p>\n Advocates noted yet another disturbing new criterion: \u201cunlikely to voluntarily participate in outpatient treatment.\u201d This allows the court to mandate treatment based on a prediction that people will not seek services on their own, and an assumption that they are incapable of making informed decisions. \u201cThe most common factor for this type of determination,\u201d Fairchild wrote<\/a> in her testimony, \u201cIs that the person disagrees with the facility or provider\u2019s recommendations. This gives facilities more pathways to override a person\u2019s autonomy \u2026 where they disagree with their provider and do not consent to treatment.\u201d<\/p>\n \u201cMost people think AOT follows from a robust legal (court) process \u2014 like what many of us have seen in courtroom dramas,\u201d Jones wrote. \u201cAlthough this varies by state, there are places in which court hearings occur less than 10 percent of time, and\/or otherwise amount to brief, six-to-ten minute \u2018rubber stamping\u2019 opportunities. In most states, individuals facing an AOT order have no right to a patient advocate and no right to a state-sponsored second opinion (psychiatrist or other evaluator of their choosing). This is most definitely not what most of us have in mind when we think about \u2018procedural due process<\/a>.\u2019\u201d\u00a0\u00a0<\/p>\n Often missing from the conversation are the voices of people currently or formerly on these treatment orders. As journalist Rob Wipond reported<\/a>, a 2023 Treatment Advocacy Center satisfaction survey is deeply biased, with clinicians cherry-picking respondents. Michael Simonson\u2019s 2019 survey<\/a> of 28 people impacted by treatment orders depicts a very different, mostly negative, picture of the experience.<\/p>\n As a researcher, Jones has spoken to many recipients of the treatment orders, as well as the judges and clinicians involved in implementing them. \u201cDirect stories of what clients\/service users are put through are deeply disturbing,\u201d she wrote. \u201cThe level of neglect and abandonment of some on AOT orders can be gut-wrenching to hear.\u201d<\/p>\n \u201cWhile of course there are kind and thoughtful providers and staff,\u201d she added, \u201cFar too many individuals I\u2019ve met invoke some of the worst, most harmful stereotypes and slurs I\u2019ve ever come across. To see this level of prejudice normalized to this degree, is actually pretty terrifying. And it\u2019s only a short stone\u2019s throw \u2026 to Brian Kilmeade\u2019s public advocacy<\/a> for \u2018lethal injections,\u2019\u201d referring to the disturbing comments made by the Fox News host who called on the state to execute unhoused people. \u201cWe\u2019re not just talking about individual dehumanization, but dehumanization of an already ultra-marginalized group on a systems level.\u201d<\/p>\n A Persistent Mischaracterization of the Problem<\/p>\n Pro-force advocates at the November 18, 2025, hearing, largely family caregivers, told horrific stories of trying to get timely and quality care for their adult children in Massachusetts\u2019 labyrinthine systems of punishment, confinement, and abandonment. They shared devastating testimony of their loved ones\u2019 encounters with police; of their children repeatedly rotating between psych wards, prisons, and the streets; and of loved ones who took their own lives.<\/p>\n At least two of the parents who testified noted that they already had access to every possible lever of state power, including Rogers guardianships<\/a>, to compel their loved ones to follow prescribed treatment, yet they had failed to force their adult children to take medication.<\/p>\n Few ever bother to ask why individuals \u201cgo off their meds.\u201d U.K. psychologist Dr. John Read, who has researched<\/a> this question in-depth, has written in the past that respondents cite a lack of informed consent<\/a> as well as an average of 11 adverse effects of antipsychotics and concerns with long-term health outcomes (well-founded, as these drugs can induce fatal cardiac events<\/a> and metabolic disorders<\/a>). Western biopsychiatry has produced dismal outcomes<\/a>, including early mortality, for people with \u201csevere mental illness\u201d labels.<\/p>\n Family caregivers and medical authorities explain away any resistance to treatment using the controversial concept of \u201canosognosia<\/a>,\u201d a term inappropriately borrowed from neurology and often used interchangeably with \u201clack of insight,\u201d to describe people who reject their diagnosis and medication or other treatments. While people can and do enter into various states, or say and do things that get labeled by systems and society as \u201clack of insight,\u201d applying force and coercion in such circumstances only serves to increase mistrust and drive individuals further away from care, as many individuals testified at the hearing.<\/p>\n There are many paths beyond the extremes of force and abandonment to support people who would otherwise be eligible for coercive programs like involuntary outpatient commitment. Abolitionist<\/a> organizers have long called for anti-carceral community crisis <\/a>supports<\/a> and providing the kind of care that people want<\/a>, while ensuring that everyone\u2019s needs for food, shelter, meaning, and human connection<\/a> are met. Permanent supportive housing programs for disabled people, like Housing First<\/a>, have long been a target of the right<\/a>, and are on Trump\u2019s chopping block.<\/p>\n Liberatory community supports already exist in Massachusetts, like Wildflower Alliance\u2019s peer respites, a nonclinical, anti-carceral alternative<\/a> to emergency rooms and locked facilities. A bill<\/a> for expanding their availability in the state, including respites for BIPOC<\/a> and LGBTQ+<\/a> people, is also currently before the legislature. Enduring Connections<\/a>, a new program, also proposes to serve as an alternative to forced intervention, centering consistent, patient outreach led by peer workers. Psychiatric advance directives, health care proxies<\/a>, self-directed care<\/a>, and supported decision-making<\/a> all allow people to exercise their legal capacity. There is no shortage of ideas, just a lack of political will to implement them.<\/p>\n \u201cI wonder what\u2019s possible if we stopped putting so much energy into going back and forth over this year after year, and truly focused on innovative, trust-building community supports,\u201d testified Sera Davidow, co-founder of the newly formed Wildflower Roots<\/a> and a longtime activist<\/a> who has written<\/a> and spoken<\/a> extensively on involuntary outpatient commitment<\/a>. \u201cI hope we get to find out.\u201d<\/p>\n This article<\/a> was originally published by Truthout<\/a> and is licensed under Creative Commons (CC BY-NC-ND 4.0)<\/a>. Please maintain all links and credits in accordance with our republishing guidelines<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"By Leah Ida Harris This article was originally published by Truthout Massachusetts is now one of only two…\n","protected":false},"author":2,"featured_media":316468,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[60],"tags":[97,259,260],"class_list":{"0":"post-316467","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"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/316467","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=316467"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/316467\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/316468"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=316467"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=316467"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=316467"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}