Forty-five states permit the use of assisted outpatient treatment (AOT), court-ordered treatment (including medication) for individuals who have a history of medication noncompliance, as a condition of their remaining in the community. Connecticut, Maryland, Massachusetts, New Mexico, and Tennessee do not have AOT.
A recent Duke study published in The American Journal of Psychiatry found that the mandatory AOT program known as Kendra's law in New York has saved costs. The Duke study examined costs for 634 people who received court orders between January 2004 and December 2005. It compared costs in the year before the court orders, the year after and two years after and the results suggested that if you invest in AOT and target it correctly, there are some significant savings.
The study also evaluated costs for non-Kendra’s Law patients who voluntarily used intensive services. In New York City, costs declined, but less than for court-ordered patients. This suggests that some patients respond to a judge's order to comply with treatment, even though failure to comply has no penalty except for evaluation for possible hospitalization.
This Duke study is consistent with other studies conducted in North Carolina, Washington, D.C., and Florida.
California enacted Laura's law, modeled after Kendra's Law but, unfortunately, it has only been implemented in Nevada County and a small pilot project in Los Angeles. In Nevada County, Laura's Law has proven so successful that the county was honored in 2010 by the California State Association of Counties. In announcing the recognition, CSAC said Nevada County offset public costs of $80,000 with savings estimated at $203,000 that otherwise would have been spent on hospitalization and incarceration of program participants. These cost savings in Nevada County are consistent with the other studies mentioned earlier.
In conclusion, the research demonstrates that AOT reduces the risks of hospitalization (or if hospitalized they had shorter lengths of stay), arrest, incarceration, crime, victimization, and violence. AOT also increases treatment adherence and eases the strain placed on family members or other primary caregivers. Maybe it is time for other California counties to implement Laura's Law because AOT is not only effective, but can save money.