Assisted outpatient treatment (AOT) is a civil legal mechanism through which a court mandates an individual’s participation in community-based mental health services. AOT is intended to help people with mental illnesses engage—or re-engage—in community-based treatment that can improve stability and reduce risks to public safety. Relevant services may include case management, medication management, blood or urine drug screening, individual or group therapy, vocational training, and substance use treatment.
“AOT refers to court-ordered community mental health treatment,” says Richard Van Dorn, PhD, a senior research associate at Policy Research Associates who has conducted research on AOT for more than 20 years. “The goal of AOT is to help people remain safely in the community for as long as possible. This reduces reliance on costly and limited inpatient beds, while ensuring that individuals under AOT court orders do not pose a danger to themselves or others.”
While AOT orders require participation in community-based treatment, AOT does not refer to any specific treatment plan or protocol. The services delivered under AOT may vary by program and by individual needs. AOT court orders are time-limited but may be renewed, with the length of initial orders and renewal periods differing from state to state.
“AOT can be used to help ensure that people take advantage of mental health services,” Van Dorn says. “However, the extent to which individuals benefit from AOT depends largely on the amount and quality of the services they have access to. Even with a judge or magistrate who has the best intentions, outcomes aren’t going to improve unless there is adequate funding for evidence-based community services.”
Variability in AOT
Courts—judges and magistrates—are authorized by state and local statutes to order people into community mental health treatment. However, how AOT is implemented varies widely across jurisdictions. Some courts stay actively involved, requiring regular progress reports from treatment teams and appearances by individuals under an AOT order at follow-up hearings. In other jurisdictions, judges and magistrates may not see the individuals again after the initial order is made. Enforcement of AOT orders also differs. Some courts respond to treatment nonadherence, while others respond only when a person is at imminent risk of harm to themselves or others.
Beyond court involvement, there are two general approaches to AOT: step up and step down. Step-up approaches focus on individuals who are already in the community but are not adequately engaged in recommended mental health treatment. Here, the court order is used preventively to support treatment engagement and reduce the need for more intensive, restrictive, and expensive crisis-based services. Step-down approaches focus on individuals transitioning from inpatient care back to the community. A court order is issued at hospital discharge to ensure continued participation in mental health treatment in the community, reducing the risk of relapse, rehospitalization, and harm to self or others.
“It’s important to note that while AOT approaches and implementation vary, research indicates that AOT programs can make a real difference for people who can benefit from consistent engagement with outpatient mental health treatment,” Van Dorn says. “Specifically, research tells us that when these individuals are under an AOT order, they are less likely to be hospitalized for mental health crises, are less likely to be arrested, and are more likely to engage in routine mental health services, all of which decrease system and treatment costs.”
Federal Interest in AOT
The White House issued an executive order on July 24, 2025, calling on the federal government to provide technical assistance for AOT programs and consider prioritizing grants associated with AOT.
The executive order—Ending Crime and Disorder on America’s Streets—calls on the U.S. Attorney General, Secretary of Health and Human Services, Secretary of Housing and Urban Development, and Secretary of Transportation to assess their discretionary grant programs to determine if they can prioritize grants that meet a set of criteria that includes setting and enforcing standards for AOT. The order also calls on the Secretary of Health and Human Services to provide technical assistance to AOT programs.
“AOT has significant potential to help people who are at risk of a mental health crisis and who need support,” Van Dorn says. “There is the potential here to do a lot of good, which we are optimistic about.”
“However, AOT is not a one-size-fits-all solution,” says Van Dorn. “Many people experiencing homelessness could benefit from mental health treatment. However, being homeless is not just a mental health problem—and AOT is not a solution for homelessness unless it is coupled with funding and delivery of quality mental health treatment and housing resources.”
“It’s also important to note that AOT orders should only be used for people with mental illnesses that can be successfully and safely treated in the community,” says Van Dorn. “AOT shouldn’t be viewed as a stand-alone solution to untreated mental illness, crime, or homelessness. It also shouldn’t be seen as a solution for people who really need to be treated in long-term, inpatient settings.”
Policy Research Associates’ Expertise in AOT
Policy Research Associates (PRA) is the national leader in the design and implementation of AOT programs. 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.
PRA is also a pioneer in AOT 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,” and supported research partners with national evaluations, including the Office of the Assistant Secretary for Planning and Evaluation’s “Assisted Outpatient Treatment Grant Program for Individuals with Serious Mental Illness.”
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.