Public Comment

Brief Response to Jack Bragen

By Ralph E. Stone
Sunday April 20, 2014 - 09:08:00 AM

This is a brief response to Jack Bragen's criticism of my recent article, "Results of Research Concerning Assisted Outpatient Treatment in the U.S." To begin, I wonder if Mr. Bragen actually read the Survey and Brian Stettin's research cited in my article. And yes, I am an unapologetic supporter of Laura's Law, California's assisted outpatient treatment (AOT) law.  

Here are some facts that Mr. Bragen might consider or reconsider: 

* The Survey was of the application of AOT laws in the 45 states who have such laws. Presumably, each of these states had hearings on the proposed AOT laws where members of the public could voice their support or opposition. And then the laws were passed. 

* California, for example, passed Laura's Law law in 2002, and the law was extended by the California legislature until December 31, 2017. The known supporters of AOT is long and impressive.  

* Yes, the Treatment Advocacy Center, who conducted the Survey, is a well-recognized advocate for the mentally ill and a strong supporter of AOT programs. Does this make them biased? And because of this alleged bias, did they grade the states too harshly in the Survey? I don't think so. 

* Will AOT programs eliminate homelessness? Of course not. AOT laws are not aimed at homelessness in general. They are aimed at a discrete population An AOT program allows court-ordered, intensive outpatient treatment for people with severe mental illnesses who refuse medication because their illness impairs their ability to make rational decisions. Laura's Law, for example, provides for a 180 day period of intensive treatment under the supervision of the court.  

* Can AOT programs work? Many AOT laws, including Laura's Law, were modeled after New York's Kendra's Law. The results achieved under Kendra's Law are remarkable. A 2010 Columbia University study found that individuals under Kendra's Law orders, despite greater histories of violence, were four times less likely to engage in future violence than those in a control group. Other studies show Kendra's Law reduces homelessness (74%); suicide attempts (55%); and substance abuse (48%). It keeps the public safer by reducing physical harm to others (47%) and property destruction (43%). It saves money by reducing hospitalization (77%); arrests (83%); and incarceration (87%). Other studies show Kendra's Law causes no increase in perceived stigma or coercion, and that the court orders themselves (not just the availability of high-quality services) are instrumental in the program's success. 

In conclusion, AOT laws are here to stay. Forty-five states have enacted such laws and a federal AOT grant program is a future possibility. The focus today should not be on whether we should have such laws but rather, on properly implementing AOT laws already in place, enacting such laws in the five states that do not have them, and getting all the California counties to implement Laura's Law.  

Finally, in my opinion, any intellectually honest person examining the mountain of positive evidence on AOT should embrace AOT. The mentally ill will be the ultimate beneficiaries.