Seminole Community Community Seminole Mental Health Center Mental Health Center Assisted Outpatient Treatment Assisted Outpatient Treatment Florida Model AOT Project Florida Model AOT Project 11/14/2005 11/14/2005
What is it What is it Court ordered outpatient treatment or assisted � Court ordered outpatient treatment or assisted � outpatient treatment for people with severe mental outpatient treatment for people with severe mental illness (i.e., schizophrenia, bipolar) (i.e., schizophrenia, bipolar) illness Enacted in June 30, 2004 by Governor Bush � Enacted in June 30, 2004 by Governor Bush � Effective January 1, 2005 � Effective January 1, 2005 �
Why is it needed Why is it needed Improved quality of life for clients and family � Improved quality of life for clients and family � Increased public safety � Increased public safety � Decrease costs of emergency services/legal services � Decrease costs of emergency services/legal services � More efficient use of criminal justice system resources � More efficient use of criminal justice system resources �
Improved Quality of Life Improved Quality of Life More than 15,000 Floridians with untreated � More than 15,000 Floridians with untreated � mental illness are homeless mental illness are homeless 10- -15 times more suicides among the mentally ill 15 times more suicides among the mentally ill � 10 �
Increased Public Safety Increased Public Safety More than 1000 homicides in the US are � More than 1000 homicides in the US are � committed each year by people who have committed each year by people who have untreated mental illness untreated mental illness People with untreated mental illness are nearly 3 � People with untreated mental illness are nearly 3 � times more likely to be a victim of violent crime times more likely to be a victim of violent crime Nationally it is estimated that people with � Nationally it is estimated that people with � mental illnesses are killed in police altercations at mental illnesses are killed in police altercations at a rate 4 times greater than the general public. a rate 4 times greater than the general public.
Decreased Cost of Emergency Decreased Cost of Emergency Services Services Community based treatment is approximately 10 % of inpatient � Community based treatment is approximately 10 % of inpatient � hospitalization costs. hospitalization costs. 540 individuals in FL had eight or more Baker Act emergency had eight or more Baker Act emergency � 540 individuals in FL � examinations in one 24 month period (2000 to 2001), averaging examinations in one 24 month period (2000 to 2001), averaging at least one every three months. One individual alone accounted One individual alone accounted at least one every three months. for 41 Baker Act examinations (in 2002) at an approximate cost at an approximate cost for 41 Baker Act examinations (in 2002) of $81,000 – – not including court costs, law enforcement not including court costs, law enforcement of $81,000 resources, or long- -term treatment. term treatment. resources, or long
More effective use of justice system More effective use of justice system 16- -17% of the state jail and prison inmates in 17% of the state jail and prison inmates in � 16 � Florida or approximately 16,000- -17,000 people 17,000 people Florida or approximately 16,000 suffer from a serious mental illness in 2000. suffer from a serious mental illness in 2000. Florida law- -enforcement officials handle about enforcement officials handle about � Florida law � 100 Baker Act commitments/day compared to 100 Baker Act commitments/day compared to 71 daily burglary arrests. 71 daily burglary arrests.
Outcomes being measured Outcomes being measured Objective: Subjective: Objective: Subjective: Use of emergency Perceived quality of life � Use of emergency � Perceived quality of life � � services i.e., crisis unit, services i.e., crisis unit, state hospital, private state hospital, private hospital, emergency hospital, emergency transport services transport services Arrests, days of � Arrests, days of � incarceration, cost of incarceration, cost of incarceration incarceration Homelessness � Homelessness �
Hospital and Jail Days before and after Hospital and Jail Days before and after Ulster County Clients AOT Petition -- -- Ulster County Clients AOT Petition 4284 4500 4000 3500 3000 2500 Before AOT 2000 After AOT 1338 1500 1000 588 500 199 0 Hospital Jail
Hospital and Jail Cost before and after Hospital and Jail Cost before and after Ulster County Clients AOT Petition -- -- Ulster County Clients AOT Petition $2,356,200 $2,500,000 $2,000,000 $1,500,000 Before AOT After AOT $1,000,000 $147,180 $500,000 $32,340 $21,890 $0 Hospital Jail
Hospital and Jail Days with Enhanced Hospital and Jail Days with Enhanced Services and AOT Petition Ulster County Services and AOT Petition Ulster County For this group of clients enhanced services was not effective enough to stabilize and they nough to stabilize and they For this group of clients enhanced services was not effective e needed a court order to follow treatment plan. needed a court order to follow treatment plan. 2500 2317 2067 2000 1500 Before Enhanced Enhanced 970 1000 Petition 588 500 365 199 0 Hospital Days Jail Days
Results of the Duke Study Results of the Duke Study Objective Data Objective Data Decrease in arrest rate (74%) � Decrease in arrest rate (74%) � Decrease in violence (up to 50%) � Decrease in violence (up to 50%) � Decrease in hospital admissions (74%) � Decrease in hospital admissions (74%) � Decrease in length of stay (by 20 days) � Decrease in length of stay (by 20 days) � Decrease in victimization (43%) � Decrease in victimization (43%) �
Results of the Kendra Law Patient Interviews Results of the Kendra Law Patient Interviews Subjective data Subjective data 75 percent reported that AOT helped them gain � 75 percent reported that AOT helped them gain � control over their lives control over their lives 81 percent said that AOT helped them to get � 81 percent said that AOT helped them to get � and stay well and stay well 90 percent said that AOT made them more � 90 percent said that AOT made them more � likely to keep appointments and take medication likely to keep appointments and take medication
History History Least restrictive environment � Least restrictive environment � Deinstitutionalization of the mentally ill/community � Deinstitutionalization of the mentally ill/community � mental health center mental health center Lack of services/under funding � Lack of services/under funding � Public awareness of a problem via high profile cases � Public awareness of a problem via high profile cases � 40 states pass AOT legislation � 40 states pass AOT legislation � Kendra's Law enacted in NY [41st state to adopt] [41st state to adopt] � Kendra's Law enacted in NY � 42 states pass AOP legislation � 42 states pass AOP legislation � TAC and Florida Sheriff’ ’s Association team up to s Association team up to � TAC and Florida Sheriff � increase public awareness increase public awareness Passage of SB700 by Governor Bush in FL � Passage of SB700 by Governor Bush in FL �
Where we are today Where we are today Implementation stage � Implementation stage � SCMHC under grant working with Treatment � SCMHC under grant working with Treatment � Advocacy Center (TAC) to develop Model AOT Advocacy Center (TAC) to develop Model AOT Program for Florida. Program for Florida.
Criteria Criteria Must meet standard of Clear and Convincing Must meet standard of Clear and Convincing Evidence Evidence 1) Age 18 or older 1) Age 18 or older 2) Diagnosis substantiated by 2 professionals 2) Diagnosis substantiated by 2 professionals 3) Unable to survive in community as evidenced 3) Unable to survive in community as evidenced by history and current behaviors by history and current behaviors 4) History of non- -compliance with treatment compliance with treatment 4) History of non
Criteria (continued) Criteria (continued) 5) Two involuntary admissions within 36 mos 5) Two involuntary admissions within 36 mos -or or- - - two incidents of received treatment in a forensic two incidents of received treatment in a forensic or correctional facility or correctional facility -or or- - - 1 or more violent acts toward self and/or others 1 or more violent acts toward self and/or others within 36 mos period within 36 mos period
Criteria Criteria 6) Due to mental health is unlikely to voluntarily 6) Due to mental health is unlikely to voluntarily comply with treatment and refused voluntary comply with treatment and refused voluntary placement placement 7) Needs Treatment to prevent relapse or 7) Needs Treatment to prevent relapse or deterioration deterioration 8) Will benefit from Treatment 8) Will benefit from Treatment 9) Other least restrictive means judged 9) Other least restrictive means judged inappropriate or unavailable (not necessarily inappropriate or unavailable (not necessarily tried) tried)
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