Some members of an Allegheny County board — which advises officials on services for some of the county’s most vulnerable residents — are asking tough questions about the county’s exploration of a controversial tool for involuntary mental health treatment.
New members of the county’s Mental Health/Intellectual Disabilities Advisory Board — who were confirmed by County Council last month — officially met for the first time Tuesday. The previous members’ terms expired in 2023. Though assisted outpatient treatment [AOT] wasn’t on the meeting agenda, it dominated discussion between board members and officials from the county’s Department of Human Services [ACDHS].
Board member Nev Jones criticized the county for not creating a public stakeholder process around “one of the most controversial practices in public mental health in the United States and internationally.” Donnesha Slider, another board member, pointed out that Pennsylvania’s AOT law “lacks teeth.” And yet another board member, Rachel Flinner, asked what alternatives the county had considered before moving forward. The members learned of the county’s plan from a PublicSource investigation that broke the news.
AOT is a legal mechanism for involuntarily providing treatment in the community, often including medication, to people with serious mental illness. County human services officials hope AOT will keep people out of hospitals and the criminal legal system, but some experts say coercive tactics can further harm people who are already suffering and point to mixed research findings of its effectiveness.
In late December, county officials quietly informed the Pennsylvania Department of Human Services of their plan to implement the state’s AOT law by Sept. 1.
ACDHS Director Erin Dalton explained, on a state form, that the county needs time for “necessary planning” ahead of implementation.
Dalton hedged during an interview this month, telling PublicSource the county “is still in exploration” and considering “harms and benefits.” Her equivocal comments were echoed during the board meeting Tuesday by Jewel Denne, assistant deputy director of the Office of Behavioral Health, and Kathryn Collins, chief analytics officer for the Office of Analytics, Technology and Planning.
“We really want … your input and your expertise on these very … critical decisions, hard decisions that often have to be made,” Denne told the board. “We’re all here to do the best we can for individuals and, you know, to not harm, right?”
Jones, an associate professor at the University of Pittsburgh’s School of Social Work, said she’d like Dalton to present the county’s vision to the board for transparency and public engagement while it makes decisions that will impact residents with serious mental illness and intellectual disabilities. People with lived experience of involuntary treatment should be centered in a public stakeholder process, she added.
“What’s the vision here? Because a lot has really gone wrong as we see with the whole AOT process,” she told ACDHS officials. “One would hope to never see this repeated.”
Jones, who has extensively studied AOT, was awarded a contract by New York state to co-lead a large-scale evaluation of the impacts of AOT there. She has schizophrenia and experienced involuntary treatment, which her research shows can destroy a patient’s trust in the mental health system. She said the county should focus on improving its voluntary mental health system and wraparound services to keep more people from reaching the point of crisis.
Jones said she repeatedly offered her expertise to ACDHS officials after hearing months ago that they were considering implementing AOT, but wasn’t consulted by them. She helped write a letter expressing concerns about the county’s decision-making process and the potential impact on vulnerable people to County Executive Sara Innamorato and County Council, which was signed, as of Wednesday, by 79 clinicians, academic experts, advocates and organizations in the county and across the country. She said Dalton reached out to her to schedule a meeting after she sent the letter.
After receiving the letter, Councilor Bob Macey said his “first thought was, ‘Why weren’t we informed earlier?’
“There was no transparency and we just can’t go ahead and move forward and accept something that [council wasn’t] a part of.” He noted there’s still “time to vet this particular project so that we all have a better understanding of AOT and … can be a part of the solution” for those with serious mental illness who are in crisis.
“Even if people go to outpatient treatment, it doesn’t mean they’re going to take their meds,” said Slider, a psychiatrist, a physician advisor to ACDHS and the founder of Manifest Psychiatry in Scott. Pointing out that the state’s AOT statute lacks an enforcement mechanism, she asked county officials if outpatient commitments “actually have value.”
“I can’t even use them, except for when people don’t know the law,” she added. “Otherwise, people know they can’t be made to take their meds.” She asked the officials to disclose which experts they had consulted before moving closer to implementing AOT, “so that when we make decisions, it actually has meaningful impact.”
Flinner, a school psychologist in the West Mifflin Area School District, asked for details about the “funding pool” the county would tap for AOT and if it’s “not being made available for more intensive community treatment programs.”
Venuri Siriwardane is PublicSource’s health and mental health reporter. She can be reached at venuri@publicsource.org or on Bluesky @venuri.bsky.social.
The Jewish Healthcare Foundation has contributed funding to PublicSource’s health care reporting.
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