Involuntary Outpatient Commitment Information Center

Involuntary Outpatient Commitment Information Center

MOST RECENT UPDATE: H.1801 (The house version of the bill) has been sent to study. This is good news for IOC not passing this session. Meanwhile, S.1115 has been referred to Ways and Means, and assigned a new bill number: S.2973. WE STILL NEED TO STOP THIS BILL!

H.1801/S.1115—An Act to Provide Continuum of Care for Severe Mental Illness would establish Involuntary Outpatient Commitment (IOC) in Massachusetts. It has had a hearing in the Joint Committee on the Judiciary, and the Senate side of that committee has reported the bill favorably, meaning it will move forward in the legislative process. The next committee which will consider this bill is Ways and Means.

Although this is based off of the IOC bill from last session, you can find a rough draft of a video unpacking the problems with the previous bill HERE. It pushes back on the idea that the criteria set forth in the bill for qualifying for an IOC order was reasonable or set a “high bar” for who would be included. They are typically pretty similar across years and even across states.

Similarly, a rough draft of a video responding to common claims from IOC proponents was created (and will continue to be developed) and is available HERE.

CLICK HERE TO VIEW WILDFLOWER’S TESTIMONY IN OPPOSITION TO H.1801/S.1115 (current 2025/2026 version)

CLICK HERE TO VIEW WILDFLOWER’S TESTIMONY IN OPPOSITION TO H.1694/S.980 (the 2023/2024 version)

At this time, Connecticut and Massachusetts are the only states or territories in the United States resisting implementation of Involuntary Outpatient Commitment. Maryland was also resisting, but gave in in the 2023/2024 session.

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. We refer to these types of strategies to obscure the harms and carceral logic of force as “forcewashing”, a term coined by Leah Ida Harris in their recent article covering the 2025-2026 bill’s hearing: Massachusetts Advocates Resist Dystopian Involuntary Outpatient Commitment Bill

In brief, Involuntary Outpatient Commitment (IOC) argues that some people must be forced to engage in certain treatments (taking particular psychiatric drugs, attending therapy or day programs in person, 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. Under IOC orders, these conditions are upheld under the threat of being detained by cops, and committed to a psychiatric facility under Section 12. Because IOC threatens to involuntarily hospitalize a person even for simple, technical violations (like being unable to arrange travel to a day program, etc.) this bill represents an expansion of the criteria for a Section 12 commitment. For this reason, IOC is often compared to probation or parole.

Unlike inpatient hospitalization, IOC orders can be renewed indefinitely, keeping someone under the thumb of the state and others in their lives who pushed for the authority of IOC orders in the first place. The list of people who may petition for an IOC order is lengthy. It includes everyone from clinicians, to family members, to intimate partners, to DMH, to the Director of Bridgewater, to probation, parole and other corrections officers, and more. We are concerned about this for a number of reasons, including the potential for IOC orders to be used as a tool of abuse in instances of domestic or intimate partner violence, the potential for IOC to be abused by the corrections system, and in general the violation of privacy that IOC orders represent.

Although proponents claim that IOC would only be applied to a very small fraction of people with psychiatric histories, the language of the laws being that were proposed this session in Massachusetts were vague, and as with most matters on the psychiatric front, highly subject to the opinions of providers involved in each particular situation. As such, these 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 systemically racist, and disproportionately used against Black and Brown people.

The push to bring IOC to Massachusetts was 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 now (and in the future).

*What it means for a Bill to be ‘acted upon’ in this context:

Joint Rule 10 says that committees must decide to vote on each Bill before them by the first Wednesday of February in the second year of the legislative session. In 2026, that is February 4th. The options are to vote favorably (should pass) or unfavorably (shouldn’t pass), “referred to study,” or to request an extension.

If a Bill is voted upon favorably, that typically means it moves forward to another committee. Bills often end up at the Ways and Means committee before being passed, for example. If a Bill is voted upon unfavorably, it dies there. Typically, “referred to study” is seen as another way to kill a Bill, as well. Extension requests are also not uncommon (and that is what happened in this case).

There is one exception to this which is the Committee on Health Care Financing. According to the applicable rule, “The Committee on Health Care Financing shall make final report not later than the last Wednesday of March of the second annual session on all matters referred to them on or before the fourth Wednesday of February and within 30 days on all matters referred to it after the fourth Wednesday in February of the second annual session of the General Court.”

Check out videos from people who’ve experienced force and IOC:

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.

Massachusetts Advocates Resist Dystopian Involuntary Outpatient Commitment Bill
by Leah Ida Harris

Alternatives to Coercion in Mental Health Settings: A Literature Review by Flick Grey et al

“Assisted” Outpatient Commitment Advocates Manufacture Consent Via Manipulation by Sera Davidow

OpEd: What’s Missing from Talk of ‘Assisted Outpatient’ Care by Sera Davidow

Do Clients in AOT Programs Truly Feel “Satisfied” and “Empowered” by Being Forcibly Drugged?: A Critical Analysis of 2023 Treatment Advocacy Center Report by Rob Wipond

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

Involuntary Outpatient Commitment and the Fight to Keep It Out of Massachusetts by Sera Davidow

End Kendra’s Law: Racist, Classist Practices in Involuntary Psychiatrist Persist by Lauren Tenney

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.

Wildflower Alliance/Wild Ivy Social Justice Network fact sheet on S.2973 (Current session)

Why We All Oppose An Act to Provide Continuum of Care for Severe Mental Illness (H.1801/S.1115) (Coalition fact sheet)

Massachusetts Association for Mental Health Fact Sheet on H.1694/S.980 (23/24 session)

Wildflower Alliance Info Sheet on H.1694/S.980 (23/24 session)
Wildflower Info Sheet On the Difference Between IOC, Section 12, Rogers Orders, and Guardianship

Older IOC Fact Sheet from Wildflower Alliance

About Anosognosia

Anosognosia (Ah-no-sog-nose-ee-uh) is one of the most commonly used arguments 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.

The most common factor when someone is labeled with anosognosia or is determined ‘unable’ to make their own decisions is that they’ve disagreed with the treatment recommended by their physician. In other fields of medicine, this is called withholding informed consent.

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

Forcewashing

In their coverage of the 2025/2026 hearing on MA’s IOC bill, Movement Journalist and author of the forthcoming book ‘NONCOMPLIANT’ Leah Ida Harris coined the term ‘Forcewashing’.

Forcewashing is a strategy used by the right to cloak state psychiatric violence, policing, etc. beneath the language of care. In terms of this bill is a way of “manufacturing consent” for forced treatment. This strategy has been used time and time again by supporters of IOC, and is worth understanding.

Below, we link to more resources on Forcewashing:

“Forcewashing”
by Fern Fairchild for Wild Ivy Social Justice Network’s Instagram page

Massachusetts Advocates Resist Dystopian Involuntary Outpatient Commitment Bill
by Leah Ida Harris

Alternatives to IOC & Legislation to Consider

Proponents of IOC often point to the fact that it reduces rehospitalization. This isn’t a success of IOC—it’s a function of the threats made by IOC orders. Instead, we support voluntary supports like peer respite, which have been shown to reduce rates of rehospitalization by up to 70%, without the use of force, fear or coercion. There is a bill currently being considered by the legislature to create more peer respites in MA.

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 have been supportive of positive change.

SUPPORT:
H.2231/S.1383—An Act Establishing Peer Respites Throughout the Commonwealth: This bill is a resubmission of the bill we promoted last year, seeking to increase the number of peer respites in MA, including affinity peer respites for LGBTQ+ and BIPOC communities. For more info: tinyurl.com/HD53925
 
H.2211/S.1389—An Act Modernizing the 6 Fundamental Rights: This is a new bill as of this year that seeks to expand and update the 6 Fundamental Rights, as well as establish consequences for violating the rights. For more info: tinyurl.com/HD155125
 
OPPOSE:
H.2210/S.1401—An Act to Provide More Timely Treatment of Inpatient Mental Health Care: This is a resubmission of the bill gutting the Rogers Order legislation and bypass due process to be able to force psych drugs prior to a court hearing. For more info: tinyurl.com/HD243125
 

Take Action!!!

We will need to have strong and consistent advocacy over the course of the two years, including meeting with legislators, media efforts, fact sheets and more. Stay tuned on all counts for more.