Involuntary Outpatient Commitment Information Center
THE PUBLIC HEARING FOR H.1694/S.980 CONCLUDED ON SEPTEMBER 7, 2023. WRITTEN TESTIMONY IS STILL BEING ACCEPTED.
H.1694/S.980 are Bills in the State House and Senate that propose bringing Involuntary Outpatient Commitment (IOC) to Massachusetts. At present, Massachusetts is one of only three states that do not have any IOC laws on the books.
IOC is more commonly referred to as “Assisted Outpatient Treatment” or “AOT” (and sometimes even “Community Treatment Orders” or “CTO). We do not use that language because it is essentially a strategy to make IOC sound “helpful” and hide the fact that it is an intervention rooted in force, rights violations, and pushing services that often don’t work and sometimes cause real harm.
In brief, Involuntary Outpatient Commitment (IOC) argues that some people must be forced to engage in certain treatments (taking particular psychiatric drugs, attending therapy, living in groups homes, etc.) in order to remain in the community and under constant threat of incarceration in a psychiatric facility (or potentially even a jail if they’re on probation) if they do not follow the terms of their order.
Unlike any other court process related to the psychiatric system, IOC does not need to consider whether or not the person is seen as competent to make decisions about their own treatment or what they would likely do based on their cultural and other beliefs if they were believed to be competent (i.e., the substituted judgement principle), or whether or not they are seen as posing an “imminent risk of harm to themself or others.”
Although proponents claim that IOC would only be applied to a very small fraction of people with psychiatric histories, the language of the current laws being proposed in Massachusetts is vague, and as with most matters on the psychiatric front, highly subject to the opinions of providers involved in each particular situation. As such, such laws are primed for abuse and drift in how they are applied. Data from other states already tells us that – as with all interventions that involve force – laws of this nature are disproportionately applied to Black and Brown people.
The push to bring IOC to Massachusetts is particularly strong this year. It is critical that as many people as possible push back consistently until this fight is over.
This page is dedicated to helping the fight.
Articles on IOC
Here, you will find articles on the fight to keep Involuntary Outpatient Commitment out of our state, media bias in covering IOC, IOC failures to improve conditions, and more.“Assisted” Outpatient Commitment Advocates Manufacture Consent Via Manipulation by Sera Davidow
OpEd: What’s Missing from Talk of ‘Assisted Outpatient’ Care by Sera Davidow
Involuntary Outpatient Commitment is Bad Public Policy by Center for Public Representation, Mental Health Legal Advisors Committee, Disability Law Center, and Committee for Public Counsel Services
Stories from People Subjected to AOT Orders: I Didn’t Know Stuff Like This Existed compiled by Michael Simonson
New Expansion of Kendra’s Law in New York by Ethan Garinger-Sameth
WBUR Misleads with Story on Involuntary Outpatient Commitment by Sera Davidow
Twenty Years After Kendra’s Law: The Case Against AOT by Robert Whitaker and Michael Simonson
The Problem with Laura’s Law by Michael Gause
Truth and Human Rights in Mental Health by Sera Davidow
Fact Sheets on IOC
Here, you will find basic fact sheets on IOC and related concepts.
Anosognosia (Ah-no-sog-nose-ee-uh) is the most commonly used argument by proponents to justify IOC laws. Anosognosia is a neurological condition present in some people who’ve had strokes or similar. Some people claim it is also present in certain people with psychiatric diagnoses, leaving them unable to understand that they have a problem (i.e., “lack of insight”). However, there is no real medical basis for using this neurological diagnosis in this manner.
Here, you will find articles explaining what Anosognosia is, and how its getting misused to justify violating the rights of people with psychiatric diagnoses:
Fighting Outpatient Commitment in Massachusetts by Sera Davidow
How Conjecture Became Medical Fact, by psychiatrist Sandy Steingard
Denial of Mental Illness Not Neurological by psychiatrist Larry Davidson
People who support IOC laws in Massachusetts have written articles, OpEds, and letters to the editor. They have formed coalitions, and published ads on TV and radio. In order to fight back, we also need to take action. The best things you can do are:1. Sign-up to testify at the IOC public hearing (new date TBD)2. Submit written testimony in addition to (or instead of) oral testimony (we recommend doing this once the new hearing date has been announced)3. Help create a steady flow of letters and phone calls to the Joint Committee expressing your opposition to S.1694/S.980. Click here for instructions! (We recommend NOT waiting, as they are hearing from people in support of the bill in high numbers right now.)4. Share this page, and/or the articles and fact sheets included here on your social media, and with your friends and family. People are much more likely to pay attention when information is coming from someone with whom they have a relationship!
CLICK HERE TO VIEW WILDFLOWER’S WRITTEN TESTIMONY!
Legislation to Consider
A successful effort to stop IOC will include not only the reasons why NOT to bring IOC to Massachusetts, but what we are doing or could do instead. In general, quality voluntary options are far more effective than any version of force and coercion. Below are some examples of legislation that would support a move in this direction.
Alternative Crisis Responses: One such Bill worth considering for support is H.2264/S.1407, an Act to create equitable approaches to public health. This Bill would involve Community Health Workers, Peer Supporters, and Social Workers in providing alternative crisis responses, and more. The public hearing scheduled for this Bill was postponed, and a new date has not yet been scheduled. You can learn more about this Bill here.
Peer Respites: Another Bill to consider for support is H.3602/S.1238, An Act establishing peer-run respite centers throughout the Commonwealth. This Bill would establish at least one peer respite per county across Massachusetts, including the first LGBTQIA+ peer respites in the world. Peer Respites are supported by a growing body of research that demonstrates them to be effective in supporting people to learn from their experiences, and avoid more invasive interventions like inpatient holds.Visit the Info Center for this Bill here.
Eliminating Unnecessary Hospitalizations: Yet another Bill worth considering is H.1980, An Act relative to ending unnecessary hospitalizations and reducing emergency department boarding. This is another Bill that supports the creation of sustainable, voluntary alternatives to force and psychiatric holds.
On July 18, 2023, a public hearing was held on IOC. However, it was interrupted by an electrical fire at the State House. Although Representative Matthew Muratore, Senator Cindy Friedman, and psychiatrist Jhilam Biswas got to testify before the alarms went off, no one else was first, and the hearing was postponed.The second part of the hearing occurred on September 7, 2023 running from 1pm to 5:15pm. The hearing covered a number of Bills, but spent the majority of the time hearing people on H.1694/S.980. A summary of the hearing will be available here soon.
People unable to attend the hearing may also submit written testimony by e-mailing firstname.lastname@example.org. Written testimony will continue to be accepted until action is taken on the Bill. (There is no clear date when that will happen, so it is best to send written testimony as soon as possible.)
You can see what other Bills will be heard in that hearing by clicking HERE.
See the ‘Take Action’ section on this page for guidance on sending written statements to the legislature.