p2 what is aot
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Treatment Advocacy Center • TreatmentAdvocacyCenter.org
What is AOT?Assisted outpatient treatment (AOT) for provides court-ordered mental health treatment – including medication – in the community for those with a severe mental illness who have a history of poor outcomes caused by their inability to maintain treatment voluntarily.
THOSE MOST IN NEED: AOT serves the most severely ill, who cycle in and out of jails, hospitals and the streets because their illness prevents them from understanding they need care. Due to strict legal criteria, AOT recipients typically represent far less than .05% of a state’s popula-tion, yet, on any given day, they make up 25% or more of those living on the streets, behind bars, or in crisis care.
AOT RECIPIENT CHARACTERISTICS:
•Majorityhaveschizophreniaorseverebipolardisorder
•97%percenthadbeenhospitalizedpreviously
•47%hadco-occurringsubstanceabusedisorder
•47%didnotadheretoneededmedicationregiment before AOT
THE REVOLVING DOOR’S COSTS: Each psychiatric readmissioncostsonaverage$7,500.iMedicationnon-compliance is the number one risk factor.ii AOT greatly increases medication adherence and reduces costs from re-admission.iii
HUGE COSTS TO PUBLIC HEALTH SYSTEMS:Mentalillnessesaccountfornearly20%ofallMedicaidre-admis-sions.ivMedicaidpatientshadmorethan75,000mentalhealth re-admissions within 30 days in one year.v Nearly 25%ofMedicarepatientswithpsychoseswerereadmittedwithin one month of discharge.vi
AOT REDUCES ARRESTS & VIOLENCE
44% decrease in harmful behaviors
2/3 reduction in risk of arrest
in any given month
4x less likely to perpetrate
serious violence
1/2 as likely to be victimized
AOT WORKS: Of participants in New York’s AOT program, called Kendra’s Law:
AOT SAVES MONEY
50% cost savings in New York
40% cost savings
in North Carolina
40% cost savings
in Summit County, Ohio
$1.81 saved for ever dollar spent in Nevada County, California
77%fewer experienced psychiatric hospitalization
83%fewer experienced arrest
74%fewer experienced homelessness
87%fewer experienced incarceration
BROAD SUPPORT FOR AOT
• InternationalAssociationofChiefsofPolice
•NationalSheriffs’Association
•DepartmentofJustice
•AmericanPsychiatricAssociation
i Hauert,A.,Johnson,E.,Kirpalani,N.,Martin,J.,&Miller,D.(2012).Thecostofhealthcare, does more care = better care? Perspectives, 8.
iiMorgan,L.(2014).WhatdrivesMedicaidbehavioralhealthreadmissionrates?RetrievedMarch30,2015fromhttps://www.openminds.com/market-intelligence/executive-briefings/drives-medicaid-behavioral-health-readmission-rates.htm/
iii HealthManagementAssociates.(2015).State and community considerations for demonstrating the cost effectiveness of AOT services.Lansing,MI:HealthManagementAssociates.
iv Trudnak,T.,Kelley,D.,Zerzan,J.,Griffith,K.,Jiang,H.,&Fairbrother,G.(2014).Medicaidadmissionsandreadmissions:understandingtheprevalence,payment, and most common diagnoses. Health Affairs.RetrievedMarch30,2015fromhttp://content.healthaffairs.org/content/33/8/1337.abstract?rss=1
v Hines,A.,Barrett,M.,Jiang,H.,&Steiner,C.(2014).Conditions with the largest number of adult hospital readmissions by payer, 2011.HealthcareCostandUtilizationProject.
vi Jenks,S.,Williams,M.,&Coleman,E.(2009).RehospitalizationsamongpatientsinMedicaidfeeforserviceprograms.New England Journal of Medicine,360:1418-28.