Assisted Outpatient Treatment (AOT) is a civil court mandate that requires individuals to participate in community-based mental health services. AOT research shows that these programs can benefit both individuals and the public, but only if the right conditions are in place.
How We Know What AOT Can Do
AOT has been around for more than 25 years, and experts at Policy Research Associates (PRA) have played a role in implementing – and studying – AOT programs from the beginning. AOT research from PRA has been key to understanding the benefits that result from implementing programs and has highlighted the features that are essential to securing those benefits.
“Our research makes clear there are specific policy elements required to make AOT work, and outlines how those policy elements need to be implemented in practice,” says Chanson Noether, a vice president at PRA with decades of experience working with AOT programs. “Successful AOT programs require planning, strong community partnerships, and adequate funding. These programs are tied to the legal system, but must address needs such as clinical services, housing, and community supports. All of these needs must be addressed to achieve the best possible outcomes.”
Does AOT Save Money?
The short answer is yes – but jurisdictions have to spend money to realize those savings.
A landmark 2013 study from PRA researchers evaluated the State of New York’s AOT program, one of the first in the country. In it, the researchers found the AOT program required a substantial investment of public resources to meet the needs of individuals enrolled in the program – providing access to mental health services and housing support. However, that increased spending was more than offset by reduced overall costs associated with individuals who had serious mental illness.
In short, people who were enrolled in the AOT program were less likely to incur costs related to services such as hospitalization – which reduced the state’s average costs for people enrolled in the program by 50-62%.
Does AOT Improve Patient Outcomes?
Yes. A 2025 PRA study of six AOT programs found that these programs can make a meaningful difference for individuals with serious mental illness.
The study found that individuals enrolled in AOT programs were more likely to adhere to their treatment, reported higher levels of life satisfaction, and were less likely to consider suicide. Individuals who participated in AOT programs for six months also had a 40% reduction in the likelihood of having to be hospitalized for inpatient mental health treatment. And, after six months, individuals in AOT programs were less likely to be experiencing homelessness.
The study also underscored that it is the quality of the treatment and support services provided that leads to these benefits. AOT itself only serves as a tool to get people to accept that treatment and support.
Does AOT Reduce Arrests?
Yes. The 2025 study found that individuals enrolled in AOT programs saw a reduction in violent behavior and illicit drug use. What’s more, the study found that the proportion of patients with arrests decreased by almost 20%.
The findings were consistent with a 2010 study by PRA of individuals enrolled in New York’s AOT program. That study found the odds of arrest among AOT recipients were relatively low – while they were enrolled in the program. The findings suggest that this decreased likelihood of arrest is related to increased engagement with relevant mental health services, including ongoing supervision and monitoring of behavior, and increased adherence to appropriate mental health medications.
What AOT Research Tells Us
“The empirical evidence of the most ambitious studies that have been done on AOT shows that well-designed AOT programs accomplish the goals of getting people to participate in treatment, making them less likely to be hospitalized, and making them less likely to be arrested,” says Hank Steadman, founder of PRA and a longtime AOT researcher.
“But AOT programs only work if people have access to the services they need,” says Melissa Stein, a senior project associate at PRA whose area of expertise includes AOT.
“Providing the essential services associated with AOT programs is expensive – but not providing these services is also expensive,” says Stein. “If we provide services as part of an AOT program, jurisdictions save money and improve the quality of life for citizens. If those services are not funded up front, then jurisdictions have to deal with more expensive scenarios that stem from people who are in crisis or who are cycling through the legal system or psychiatric hospitalization.”
“PRA is founded on the principle of conducting research that matters so that our partners can make informed decisions,” says Noether. “The research we have done on AOT is – and always has been – focused on answering questions that can help people in practice.”
Policy Research Associates’ Expertise in AOT
PRA is a pioneer in AOT research and evaluation. Our researchers conducted the first U.S. evaluation of an outpatient commitment program: Bellevue Hospital’s pilot program for court-ordered outpatient treatment in New York City, which operated from 1994 to 1997. Since then, PRA has led major evaluations, including the 2009 “New York State Assisted Outpatient Treatment Program Evaluation.”
Our evaluation expertise spans single-site, multi-site, and state-wide studies addressing AOT policy design, resource needs, service delivery, outcomes related to public safety and individual well-being, and program costs. With this depth of experience, PRA is uniquely positioned to guide jurisdictions seeking to build, expand, enhance, and evaluate their AOT initiatives.
PRA is also the national leader in designing and implementing AOT programs. PRA’s expertise in this regard has included work with grantees of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) “Assisted Outpatient Treatment Grant Program for Individuals with Serious Mental Illness,” authorized under the 2014 Protecting Access to Medicare Act, since its inception in 2016, supporting the initial cohort of 18 grantees and, more recently, with new cohorts. Our team brings decades of experience delivering evidence-based AOT technical assistance that helps communities, courts, and treatment providers realize the full potential of AOT: improving outcomes for both individuals and communities.
We provide comprehensive support across all stages of AOT programming, from initial design and implementation to data-informed strategies for strengthening established programs. Our approach to AOT technical assistance is tailored, practical, and grounded in both data and field experience.