How Should We Help the Seriously Mentally Ill?
Two mental-health bills. Two different parties.



Encourage the creation of assisted outpatient treatment (AOT) pilot programs. AOT allows courts, after full due process and with strong protections, to require certain narrowly defined individuals — those with serious mental illness and a prior history of arrest, violence, or needless hospitalization caused by going off treatment — to remain in treatment (usually involving medication), under supervision, as a condition of living in the community. Perhaps more important, it allows courts to order the mental-health system to provide the treatment. The mental-health industry does not like being told that it has to serve the most seriously ill, and therefore opposes AOT. Civil-liberties zealots oppose requiring patients to take their medicine even when it can free the psychotic from the Bastille of their own psychosis.

But research shows that AOT works. After enrollment in AOT, significantly fewer recipients engaged in suicide attempts or physical harm to self (down 55 percent); physically harmed others (down 47 percent); damaged or destroyed property (down 46 percent); threatened physical harm to others (down 43 percent); experienced homelessness (down 74 percent); experienced arrest (down 83 percent); experienced incarceration (down 87 percent); or abused alcohol and drugs (down 48 percent). AOT cuts cost in half and is more humane and less restrictive than the alternatives: inpatient commitment and incarceration.

Provide money for mental-health courts and for training police officers, corrections officials, EMS, and other first responders to recognize individuals who have mental illness and learn how to intervene in a way most likely to prevent escalation.

Free parents who are caregivers from HIPAA handcuffs. To provide care for their mentally ill loved ones, families need information about their future treatments and doctor appointments. But doctors and mental-health programs routinely keep parents in the dark, hiding behind the patient confidentiality law known as HIPAA (the Health Insurance Portability and Accountability Act of 1996) to prevent them from getting the information. Neither James Holmes’s family nor Jared Loughner’s was informed about their loved one’s deterioration before their shooting rampages. This bill allows information to be disclosed to family-member caregivers if that information is needed to “protect the health, safety, or welfare of such individual or the safety of one or more other individuals.” It provides similar exceptions under the Family Educational Rights and Privacy Act of 1974, which guides what information educational institutions can provide to family members of students.

These solutions will improve care for people with serious mental illness while keeping patients, the public, and the police safer. They will also save taxpayers money and make the mental-health industry scream in protest. Sounds like a plan.

— D. J. Jaffe is a family member of someone with serious mental illness and is executive director of Mental Illness Policy Org., an independent, nonpartisan, research-based think tank on serious mental illness (not “mental health”).