Kevin's Law and Assisted Outpatient Treatment

In 2000, graduate student Kevin Heisinger, age 24, was beaten to death at a bus station in Kalamazoo, Michigan by a man who had been in and out of the mental health system and was actively delusional. After the fatal beating, the public in Michigan demanded action. Kevin’s Law, providing for assisted outpatient treatment (AOT), was enacted in 2005 and updated in 2017 and again in 2019. The newer law allows any resident age 18 or older to request that a specific adult be considered by the court for mandatory outpatient psychiatric treatment and medication. If the mentally ill individual fails to follow the stipulations of the court order, the court could order the person hospitalized for up to 10 days. The judge could also order the individual picked up by police and transported to a screening center to be evaluated for psychiatric hospitalization.

In addition to attempting to protect the public from individuals who have become violent with severe psychotic disorders, states also seek to help severely mentally ill people who may completely decompensate when they don’t take their psychiatric medication. Nearly all states and Washington, DC today have passed assisted outpatient treatment laws, with the exception of Massachusetts, Connecticut, and Maryland.

Why do some severely mentally ill patients resist treatment?

Some psychotic individuals don’t believe they are really ill (anosognosia). They lack insight and self-awareness and often refuse to take antipsychotics or other prescribed psychiatric medications.

There are other reasons why patients may end the use of their psychiatric medication. They may have lost contact with their medication prescriber. They may also be homeless and thus no longer linked to a mental health professional. Some ill individuals may have been incarcerated and unable to obtain needed psychiatric medications. When people who are severely mentally ill cannot or will not take their psychiatric medications, they almost invariably become very ill.

Advantages and Disadvantages of AOT

Although state laws on AOT vary, there are several key advantages and disadvantages to their use and implementation.

The Pros of AOT

The key advantage of living in a state with the provisions of an AOT is that it does (or may) help a severely mentally ill person who has not been taking medication to improve their mental status, basically by mandating treatment. Another major plus is that AOTs may provide important and needed services to the ill person. According to the Honorable Milton L. Mack, Jr., under Michigan’s AOT laws the court may order multiple services such as case management, medication, day or partial-day programs, supervised living, substance abuse treatment and testing, and educational training, as well as other services that could decrease the risk for relapse.

It is also known that AOTS reduce the “revolving door” risk of one psychiatric admission after another. For example, the Duke Mental Health Study reported that providing AOT for at least six months decreased the risk of readmission by nearly 60%

The Disadvantages of AOT

There’s always a “down” side to newer programs. For example, sometimes the cost for social service agencies that provide services increases greatly and can be difficult to accommodate. It is also true that sometimes state laws on AOT are vague or confusing. As a result, such laws can be ineffective, and are mostly ignored.

Evaluation of State AOT Laws

In 2020, the Treatment Advocacy Center (TAC), a mental health advocacy organization, released a report on states with the best and worst assisted outpatient treatment laws. The following states received an “A”: Michigan, Louisiana, Minnesota, and Oregon. They also rated states with the worst laws (a grade of “F”), which included Colorado, Alaska, and Delaware. States with no AOT laws received a grade of zero, which also qualified as an “F," including Connecticut, Massachusetts, and Maryland.

Conclusion

Assisted outpatient treatment (AOT) in Michigan and other states provides an important tool to help severely mentally ill people who have stopped taking their medication and have severely decompensated. In addition, as a result of these laws, worried or frantic family members and friends of the ill person may at long last believe the ill person will receive the care they urgently need. Lastly, these laws should mean fewer cases like that of Kevin Heisinger, because the public is better protected.