For the last year, Allegheny County has been exploring whether Assisted Outpatient Treatment (AOT) could be a helpful tool for improving care for people with serious mental illness who are cycling through hospitals, jails, and crisis systems; often they're without the support they truly need.

Each year, more than 5,000 people in Allegheny County are evaluated for involuntary hospitalization. The outcomes for this group are deeply troubling:

• Fewer than half get follow-up outpatient care after their crisis
• 20% die within five years

Families, providers, and partners have asked Allegheny County for new, compassionate tools to engage people in care before a crisis becomes life-threatening. AOT is one option that's being considered.

Assisted Outpatient Treatment (AOT)

Assisted Outpatient Treatment is a civil court process that supports people with serious mental illness in receiving outpatient care in the community.

Anyone (family, friends, neighbors, social service providers, etc.) could petition for a person to be evaluated for AOT, and for a court to determine its legitimacy. People subject to petitions would be notified through a summons (not a warrant) for the person to appear in court. Law enforcement would not be involved in finding the person, serving the person the summons, or ensuring the person comes to court. If the court determined the person qualifies, a clinically-developed treatment plan would be court-ordered and monitored by a judge.

The court-monitored plan lasts for 90 days, and can be extended if needed through another court hearing. If the person isn’t following their treatment plan, they could be brought back in front of the judge to discuss why it isn’t working and to adjust the plan to promote more successful outcomes.

In Allegheny County, no one would be arrested or jailed for non-compliance with a treatment plan. And, individuals who are subject to a petition are guaranteed legal defense throughout the process to ensure their rights are respected.

The goal of implementing AOT in Allegheny County would be to divert people from the justice and mental health crisis systems, and instead help people find wellness in the community. For the most acute patients, AOT could help break the negative cycle between the justice system, mental health crises, and homelessness.

Evidence

The research that has been conducted, including a recent meta-analysis in May 2025, found that AOT helped:

• Improve: appointment and medication follow-through
• Reduce: hospitalizations, suicidal thinking, and violent behavior

AOT is not a magic solution. Outcomes depend on how the treatment plan is implemented; AOT must be designed with respect for civil rights, trust in providers, and strong support services in the community.

Insights

Since November 2024, the county has actively engaged a broad range of stakeholders, including:

• Government partners
• Behavioral health providers and hospitals
• Family advocacy organizations
• Civil rights and disability rights organizations
• People with lived experience
• People working as peers with people with SMI

It's a priority to include groups that have historically raised concerns about AOT, and Allegheny County is committed to ongoing conversations to find the best treatment options for those in need who have lived experience with serious mental illnesses.

Upcoming

Under Pennsylvania law, counties are presumed to be implementing AOT unless the county chooses to opt-out. To date, the Director of the Allegheny County Department of Human Services has submitted an “opt-out” letter each year, though in past years indicated that the county would explore implementing AOT.

If Allegheny County does not submit an “opt-out” letter by the end of 2025, the county would be implementing AOT starting January 1, 2026.