The BOAT has arrived. BOAT stands for the Boston Outpatient Assisted Treatment Program. (Apparently, they reversed the order of the second and third word from what is most commonly seen to either put off being noticed, or for the purpose of forming a cute acronym.)
BOAT is being operated under the umbrella of the Boston Medical Center, one of the same organizations that operates a part of the Boston Recovery Learning Community. This serves as a painful reminder as to why it is so important that peer-to-peer supports should not be overseen by a conventional and clinical “mental health” agency or group. Being lumped in with so many force-laden, rights-violating services can only serve to reduce trust in what is meant to be an alternative to the system and where power imbalances are supposed to be reduced as much as possible. Many will see peer supporters (both those operating within BOAT and those less directly connected by operating under the same umbrella organization) as complicit in what happens there.
What so frequently gets called “Assisted Outpatient Treatment” or “AOT” is not as friendly and supportive as it sounds. It is a way of forcing someone perceived to be a risk in some way to engage in court-ordered services. Most often the order focuses on taking psychiatric drugs under threat of being put involuntarily in a psychiatric facility upon refusal. However, it can also include any number of other requirements such as participation in a day treatment program, living in a group home, and many other points.
Activists routinely point out how Involuntary Outpatient Commitment (aka “AOT”) is like being put on strict probation without ever having been convicted of a crime, and see it as extremely discriminatory and harmful. Furthermore, as so many clinical treatments are more and more being seen as having low efficacy and relatively high risk for harm, people are rightfully questioning why it would be okay to ever force someone into them. Some may even recall that Norway recently declared forced drugging with the class of drugs called ‘antipsychotics’ to be illegal because of low rates of demonstrated efficacy. Research also routinely highlights the reality that courts apply their decisions in a racially discriminatory manner, including when it comes to orders of forced mental health treatment. Existing data demonstrates that black and brown people are more likely to be subjected to these orders of force in areas where it already exists.
Massachusetts is still considered to be one of the only remaining states in the country to not have instituted an “Assisted Outpatient Treatment” law. Whenever legislators have tried, they’ve received substantial pushback from advocates around the state. However, BOAT was able to get funding and be implemented without anyone really noticing. Why? Because apparently their status as a “demonstration project” allows them to test out the approach without legislation being passed. Because legislation wasn’t being passed, there were no public notices issued during the review process. And so now, here we are.
Fortunately, BOAT—as funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) – is limited in its scope and geographical reach. It is restricted to working only with people in the Roxbury area who have already been involved in the court system. But, that still includes a wide swath of our community who stand to be harmed, and should not be disregarded. However, the biggest risk is what it could mean for legislation to get passed fully implementing this type of forced treatment across the state.
Exactly how BOAT operates is somewhat unclear, but what is being offered to the public can be found on the Boston Medical Center’s website. We hope to continue to collect more information on this new program to share it with you, including how to make sure it does not spread.
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