Assisted Outpatient Treatment: A Blueprint to Freedom
By Eric Smith
Psychiatrists who have seen me at my worst diagnose me with schizoaffective disorder. Psychiatrists
who have not seen me at my worst diagnose me with bipolar disorder. Both of these diagnoses are forms of serious mental illness (SMI).
People languishing in the abyss of SMI need all the help they can get, but not everyone advocating on behalf of those diagnosed with SMI understand the needs of this population.
I support disability rights, civil rights and other related advocacy groups. They help ensure that people are not taken advantage of, neglected, or abused. But no one experiencing psychosis who cannot perceive objective reality should be making decisions about their own medical care. I do not say this because people with untreated/under-treated SMI are undeserving of freedom or choice, but because they are incapable of making rational, volitional choices while being held hostage by their own mind.
Advocating for a person in a decompensated state of mind to be able to refuse treatment is not a protection of liberties. Rather, it serves to deny a diagnosed person’s ability to pursue liberty and choice, as liberty and choice are suffocated by the presence of untreated/under-treated SMI.
Looking back, I now realize how ill-equipped I was to make important decisions for myself prior to my first hospitalization for mental illness. I once sat awake for three nights in-a-row surfing the internet for clues about threats against world leaders before showing up uninvited at my local FBI office, where I delivered a psychotic rant to several visibly concerned FBI agents.
After my rant, one of the agents asked me if I had been prescribed psychiatric medication. I had a bottle of medication in my pocket that I took out and slammed down on his desk. He told me I needed better treatment from mental health professionals.
He was and is right, because a person who stays awake for several days using a hotel’s business center to decipher a code that does not exist followed by a meeting with the FBI to discuss non-credible threats is a person in need of treatment and care.
When living in the false reality of SMI’s unforgiving landscape constructed by the usual suspects of symptoms mentioned above, freedom, choice, and liberty cannot and do not exist until one becomes stabilized and sane. Assisted outpatient treatment (AOT) is one of the best ways to accomplish this, and does so by way of civil/non-criminal court proceedings, recognizing mental illness is not a crime.
When I received AOT, I was regularly involved in decisions about my treatment and care with thanks to my AOT treatment team (a psychiatrist, judge, social worker, and others).
When my medications were causing severe side effects like rapid weight gain and persistent upset stomach, my AOT treatment team explored and found alternatives. I was able to change medication multiple times based on my feedback to the AOT treatment team. The argument I sometimes hear that AOT participants are not involved in choices about their own treatment and care is categorically false.
When I was not psychotic, those overseeing my care valued my feedback, and when I was psychotic, my feedback was not of meaningful consideration to those overseeing my care -- which is exactly how it should be.
In an emergency room, if someone loses consciousness and cannot breathe, a likely next step would be for doctors to intubate as a life-saving measure. The decision to intubate would be made by medical experts, even though the person being intubated is not conscious to approve this action.
No reasonable doctor would wait for a person to regain consciousness before asking the patient if they wanted to be intubated. The same logic applies to treating people in the depths of SMI, where doctors (and others) can step in, and engage in life-saving treatment, even if the person with SMI is not consciously aware they need treatment and care.
You no doubt understand that a person who loses consciousness because of not being able to breathe needs medical choices to be made on their behalf. But perhaps you also believe that those experiencing psychosis are not in need of medical choices to be made on their behalf if their eyes are open and they are voicing opposition to receiving treatment and care.
If you fall into the latter camp, you must understand that untreated and under-treated SMI result in a loss of consciousness. You cannot argue that someone who is sleepwalking is conscious. Likewise, you cannot argue that someone who is psychotic is conscious.
Untreated and under-treated SMI require medically necessary life-saving treatment and care, so we must all allow doctors and treatment teams to do their jobs: saving lives.
Eric Smith is a mental health advocate, public speaker on matters of mental illness, and graduate student
