The Halloween triple-murder in Bono, Ohio of William Liske, Jr., his wife Susan, and son Derrick has again focused the public's attention on what to do to prevent violence by people with serious and untreated mental illnesses. If media reports holds up, the murderer was their son William 'B.J.' Liske "who has suffered from schizophrenia and at one time has been off his medications." A violent past was also suggested.
Six rigorous investigations by multi-disciplinary teams just published in October, 2010 Psychiatric Services--combined with previous research--shows Assisted Outpatient Treatment (AOT) could help prevent incidents like this. AOT reduced arrests, homelessness, hospitalization and violence among people with mental illness.
AOT is a law that allows courts to order treatment for certain individuals with very serious mental illness who refuse treatment and have a past history of becoming violent without it. This is the small discrete subgroup most likely to become violent in the future. In addition to committing the patient to accept the treatment, under the "Model Law" AOT 'commits' the mental health system to providing it. All patients are 'forced' to accept a case-manager who facilitates services and monitors compliance. Other services like medications, day-treatment attendance, and substance abuse services are determined by negotiation between the patient's lawyer, and the mental health system and must then be approved by the judge. AOT takes place in the community, making it less restrictive, less expensive and more humane than its alternative: inpatient commitment.
The six studies were based on interviews with patients and an analysis of AOT administrative and clinical services data from New York State which has the most extensive program ("Kendra's Law") involving about 3,000 individuals. The studies span nearly a decade and were conducted largely at the behest of the few who thought it unconstitutional or who doubted AOT would work. Here's are major findings:
"The odds of arrest for participants currently recieveing AOT were two-thirds lower..."
"(T)he likelihood of psychiatric hospital admission was significantly reduced by approximately 25% during the initial court order"
(Patients) who received court orders for AOT appeared to experience a number of improved outcomes: reduced hospitalization and length of stay, increased receipt of psychotripic medication and intensive case management services, and greater engagement in outpatient services."
Benefits of (AOT)...as indicated by improved rates of medication possession and decreased hospitaliations were more likely to persiste after (AOT) ends if it is kept in place longer than six months.
"In the long run...overall service capacity was increased, and the the focus on enhanced services let to greater access to enhanced services for both voluntary and involuntary patients."
"Taken as a whole," writes Marvin S. Swartz, MD, guest editor and professor of psychiatry at Duke University School of Medicine, the reports "suggest that New York State's AOT program can improve a range of important outcomes for consumers, apparently without feared negative consequences, such as dissatisfaction with services received under court-ordered treatment."
Approximately 1500 murders a year may be committed by individuals with serious and often untreated schizophrenia. The Liske family may have been the most recent three.
California, Tennessee and numerous other states are considering adoption or implementation of AOT Laws. The results of the largest and longest studies show they're on the right track. AOT helps people with mental illness and keeps the public safer.
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