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United Way of Lancaster County


Without state funding, counties balk at implementing ‘assisted outpatient treatment’

Lancaster County Government Center, 150 N. Queen St. (Photo: Tim Stuhldreher)

Lancaster County Government Center, 150 N. Queen St. (Photo: Tim Stuhldreher)
Lancaster County Government Center, 150 N. Queen St. (Photo: Tim Stuhldreher)

Like its peers around the state, Lancaster County in 2022 will once again exercise its right to opt out of offering an assisted outpatient treatment program.

"The reasons to opt out continue to be the same," Behavioral Health & Developmental Services Director Judith Erb told the county commissioners Tuesday. All three commissioners concurred with her recommendation.

Assistant outpatient treatment, or "AOT," is an alternative to involuntary commitment for the small cohort of individuals with the most severe forms of mental illness. People in AOT are subject to court-ordered treatment plans but can remain at home or in a community setting, rather than being institutionalized.

Proponents say AOT reduces costs while yielding positive outcomes, stabilizing individuals who are at high risk of hospitalization, arrest or homelessness.

Gov. Tom Wolf signed the law authorizing AOT in October 2018. However, it provided no state funding. Despite proponents' claims that it saves money, mental health administrators say they're wary of the potential of an AOT program to put further strain on already-scarce mental health dollars.

Potential outlays for AOT include training, court costs, evaluation and treatment costs and court-ordered ancillary social services, Erb said. The county could even end up on the hook for providing housing if a judge ordered it, she said.

There are also concerns about legal liability and enforcement. Accordingly, until this year, none of the state's 48 county or multi-county mental health departments were willing to offer AOT, instead notifying the state annually that they were opting out.

Recently, that blanket refusal slightly eased up slightly. Three mental health departments have elected to set up pilot AOT programs using supplementary funding they received: Bucks County, Dauphin County and the joint mental health and developmental services program of Carbon, Monroe and Pike counties.

The pilot programs will demonstrate whether AOT is financially sustainable, Erb said. If it isn't, the counties will be able to opt out once again when the pilot programs wrap up.
She said she'll be looking to see how the experiments pan out.

Kim McDevitt, executive director of Mental Health America in Lancaster County, said she agrees opting out is the right move at this point.

"The current commitment process meets the need for most," she said. "We need to bring additional funds into the mental health system before we add more costs and more regulations that take the rights of the individual away."