A collaborative effort by courts and treatment systems to improve outcomes for those in need of mental health treatment
By Brittany Kelly, State Court Behavioral Health Administrator • Office of Behavioral Health
Nationwide more than 70% of incarcerated individuals have at least one diagnosed mental illness, substance use disorder, or both. To address this, justice system stakeholders, behavioral health experts, and community leaders are called upon to examine their systems and community resources to provide the best response to individuals with mental illness.
And that’s exactly what has happened in Lake County. An interdisciplinary team of court and behavioral health professionals sought and won a Substance Abuse and Mental Health Services Administration grant to operate an assisted outpatient treatment program for individuals with serious mental illness in Lake County.
The four-year grant, which they began implementing in September 2024, is an annual award of $750,000, totaling $3,000,000. The team includes Lake County Judges Julie Cantrell and Marissa McDermott; William Trowbridge, president and chief executive officer of Regional Care Group; and William Mescall, mental health director of the Lake County Jail.
Judge McDermott, presiding over Lake County Circuit Court Civil Division, hopes the program can address the intersection of mental health and the justice system.
“We want to create an environment where individuals are set up to succeed and where they have accountability and support along the way to achieving and maintaining wellness. Ultimately, a program like this helps public officials more efficiently use their resources toward the goal of a safer society and healthier population.”
William Trowbridge, president and CEO of Regional Care Group, hopes the AOT program will support individuals in the community and reduce the strain on community resources.
“The ultimate goal of the program is to address the needs of individuals whose mental health challenges—not criminal intent—have led to repeated interactions with police, emergency rooms, and the justice system.”
What is AOT?
Assisted outpatient treatment is the practice of providing outpatient treatment under civil court order to individuals with severe mental illness who have demonstrated difficulty engaging with voluntary treatment. According to the Treatment Advocacy Center, this type of treatment has been shown to dramatically reduce hospitalization, criminalization, and other adverse outcomes for its target population. AOT is authorized by statute under Ind. Code 12-26-14, and dedicated programs allow this type of treatment to reach its full potential.
An AOT program is a collaborative effort by the court and treatment systems to identify individuals in need, provide high quality services in the community, and as appropriate, transition a person back to voluntary care. Program participants are under court order to follow individualized treatment plans devised by the local mental health system.
If the participant does not adhere to treatment, the court may:
- modify the treatment plan
- order the participant to appear in court, or
- order the participant to be evaluated for possible hospitalization
Once voluntary engagement in treatment has been demonstrated, the court may dismiss the order authorizing treatment or allow it to expire, and care continues.
Reducing criminality of those with severe mental illness
Treatment nonadherence by a person with severe mental illness often leads to criminal legal involvement, but assisted outpatient treatment programs can reduce this risk, which promotes the safety of both the participant and the public. Once a person with severe mental illness becomes involved in the criminal justice system, courts can use an AOT program to connect them to treatment while properly addressing the underlying cause of their involvement and breaking the cycle of recidivism.
Dismissal of criminal charges upon civil commitment with AOT requires approval of the prosecutor. Also, AOT programs have the potential to serve as an alternative to competency restoration proceedings, relieving an over-burdened state hospital system.
Assisted outpatient treatment in Lake County
Presiding over Lake County Superior Court County Division 3, Judge Julie Cantrell recognized that the criminal justice system is unable to tackle this problem alone.
“There really is a difference between people who commit crimes because of their mental health issues and people who are criminals who happen to have mental health issues. Unfortunately, we see the first category of individuals repeatedly. They are an underserved portion of our population. They cost the county large amounts of money based on repeated short-term incarceration with no real hope of improving their situation. When we release [people with severe mental illness] from short-term incarceration we expect to see them again soon. We sat down as a group to look for solutions. This is an attempt to eliminate incarceration all together for those with mental health issues.”
Dr. William Mescall, Lake County Sheriff’s Office Jail Mental Health Director, discusses the cost-savings associated with an AOT program.
“Many individuals with serious mental illness are capable of living active and productive lives in the community, as long as they remain in treatment. Keeping these individuals out of jail and in treatment promotes long-term recovery and reduces costs at both the local and state levels.”
Learn more
To coordinate statewide efforts and aid Indiana courts in addressing the serious mental health and substance use issues they confront daily, Chief Justice Rush established the Office of Behavioral Health.
courts.in.gov/admin/behavioral-health
If you are interested in learning more about bringing an assisted outpatient treatment program to your community, contact [email protected], State Court Behavioral Health Administrator.
Additionally, the Treatment Advocacy Center will be hosting an AOT Conference at the end of March 2025. See aotconference.mightycrow.com.