A Public Source article from May 13th revealed the health department’s plans. From this and some other sources a few things are apparent.
One, the fix is in. Erin Dalton, the DHS director, tried to convince Public Source that no decision had been made yet, but this was directly contradicted by a representative from the Public Defenders office, who said “This is the first time I’m hearing that there may not be a completion to this project.” In addition, a letter from Dalton to the state Office of Mental Health and Substance Abuse Services, obtained by Public Source, stated flatly that “We will implement AOT in 2025.”
Dalton has also been freezing opponents of AOT out of discussions, further cementing suspicions that its implementation is a done deal. The county’s Mental Health and Intellectual Disabilities Advisory Board (MHIDAB) was not informed of the project, and learned about it for the first time from the Public Source reporter. This is very likely because Nev Jones, a new member of MHIDAB, is a professor at Pitt who has studied involuntary treatment extensively, and found that it does more harm than good. Keeping Jones in the dark as long as possible is an obvious strategy to mute opposition to AOT.
Two, the proponents of AOT represent the most reactionary elements of Pittsburgh’s social services milieu. Quoted in the Public Source article in support of AOT were Ruth Johnston of AOT for Allegheny County, and Jerrel Gilliam, director of Light of Life homeless shelter. Johnston is a suburban Karen who started AOT for Allegheny County after her son killed his grandmother during a psychotic episode. It is not clear how AOT could have prevented this tragedy. Gilliam’s ultra-religious Light of Life has a well deserved reputation as the most restrictive and authoritarian shelter in Pittsburgh. One homeless Reddit user had this to say about the place: “Please do not donate money or clothes or furniture. We never see it. I’ve seen truck loads of clothes, hygienic products and many more things put in a room locked up…”
Three, as the original Public Source piece pointed out, the MHPA does not allow for patients who skip out of treatment under AOT to be held in contempt of court. This point was further emphasized by sources quoted in a subsequent article. The implication is that AOT is harmless because patients can refuse treatment without penalty. Ironically enough, Ruth Johnston puts the lie to this fanciful delusion on the AOT for Allegheny County web site. In a section entitled What happens if someone stops cooperating? Johnston explains ‘…the AOT team has the authority to send someone to the hospital if he or she starts to “decompensate,” that is, to fare badly by being out of reality or losing self-care. State law for involuntary hospitalization still has the “clear and present danger” standard, but an AOT team is not required to wait for things to get as bad as that. Once someone is under an AOT order, it is much easier to admit them to prevent further chaos.’ In other words, anyone who does not comply with outpatient treatment can be funneled into an institution against their will, even if they never commit an offense under criminal law. Since the MHPA mandates that providers give involuntary patients top priority, already-scarce beds in treatment centers will become even harder to access by those who actually want care.
Four, AOT, in addition to being horribly arbitrary and coercive, doesn’t even work to accomplish its stated purpose. An open letter being circulated by opponents of the project cites numerous studies that found AOT in other states violates patients’ civil and human rights while damaging their mental and physical health. The few benefits involuntary patients do experience have been found to be attributable to their being moved to the tops of waiting lists for services. Obviously, this could be done without coercing them into unwanted treatment.
Erin Dalton knows all this, of course. If her true goal was to improve the state of mental health in Allegheny County, she would never have considered implementing AOT. Instead she would do everything in her power to increase mental health services so that patients could get help before their problems got to a dangerous stage. If she’s pushing for AOT instead, it’s because she would rather manage the problem than attempt to solve it. The MHPA allows police officers with no medical training to refer anyone they want to AOT. This feature makes the law an ideal instrument for getting rid of disruptive homeless people, thus appeasing the yuppie Karens that county leaders love so much. Just rounding up everyone without a place to live and sticking them in jail would never fly in our liberal city. But by exploiting AOT as a gateway to medical incarceration, Dalton hopes to sanitize the streets of Pittsburgh cheaply and quietly, using the halo of “treatment” as PR cover, and getting Medicaid and other health insurance to pay for warehousing the most noticeable members of the surplus population.
So far neither Sara Innamorato, the supposedly progressive county executive; or Bethany Hallam, the supposedly progressive county council member have uttered a word of opposition to AOT in their county. Plausible deniability just ran out for both of them. If we don’t hear anything from them in the next few days it will be reasonable to assume that they’re at least tacitly on board with Dalton, and take further steps.