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Ann Marie T. Sullivan, M.D., Commissioner
Governor Andrew M. Cuomo

AOT Procedural Questions about Investigation Process

The Director of Community Services (DCS) is responsible for coordinating local services and for the investigation of persons alleged to be in need of assisted outpatient treatment in each county. The law requires the DCS to develop an assisted outpatient treatment program to serve the community.

Can anyone call the county to start an investigation or does it have to be an authorized petitioner?

Anyone can contact the county to make an inquiry for an AOT order. It is the county's responsibility to determine if an investigation is warranted.

Is there a time frame for investigations?

County directors of community services are responsible for receiving reports of persons who may be in need of assisted outpatient treatment, determining whether or not an investigation is warranted, and, if one is warranted, conducting a timely investigation to determine the person’s eligibility for assisted outpatient treatment. Upon completion of the investigation, directors are required to provide written notice of the initiation and completion dates of the investigation and the disposition of that investigation to both the referring party and to the OMH AOT Program Coordinator.

Who does an investigation to determine if an individual meets AOT criteria if the individual is being investigated based on an authorized petitioner other than the DCS?

It is the responsibility of the petitioner to prove to the court that the individual meets all the criteria for an AOT order. Therefore, the petitioner must conduct an appropriate investigation. The county should have access to this information and be in agreement with the proposed treatment plan. However, if the county director is not in agreement with pursuit of an AOT order for a particular individual, or if the county director is not in agreement with the proposed treatment plan, an authorized petitioner may still proceed in pursuit of the AOT order. If the court is convinced that all criteria have been met, the court may then order the county director to either implement the plan proposed or devise an appropriate treatment plan which must then be implemented under the county’s direction.

If an individual is currently hospitalized, can the hospitalization be counted towards the 2 hospitalizations or incarcerations eligibility criteria?

Yes, as long as the current admission is a result of non-compliance with treatment. In such a case, the 36-month look back period would begin prior to the current admission. In other words, if an individual spent 2 months in a hospital, the look back period is extended to 38 months (36+2=38).

If an individual is presently incarcerated, can this incarceration be counted towards the 2 hospitalizations or incarcerations eligibility criteria?

Yes, provided the incarceration was a result of non-compliance with treatment and the incarceration included treatment in the mental health component of the jail or prison system.

Is it possible to obtain criminal history records?

Information is available on the Internet if (1) an individual has served time in a New York State Correctional Facility (http://nysdoccslookup.doccs.ny.gov/ Leaving OMH site) and/or (2) an individual has been categorized as a Level III Sex Offender (http://criminaljustice.ny.gov/nsor/index.htm Leaving OMH site). Local Police Departments, Departments of Probation and Parole are not obligated to share information. Individual counties may pursue cooperative arrangements with their local criminal justice systems.

If a referral is made for an 18 year old, can previous hospitalizations count?

Yes. However, it is important to determine that admissions were a result of non-compliance with treatment.

When should someone be considered for Enhanced Services (also known as Voluntary Agreements or Court Diversions) instead of an AOT order?

The decision to pursue an AOT order is a clinical determination and AOT must be considered to be the least restrictive alternative. If an individual meets most of the AOT eligibility criteria but, for example, has never received case management or ACT services before, an enhanced service package may be considered. This would involve the assignment of a new or more intensive case management service.

Does an individual have to have a psychiatric evaluation before being considered for an enhanced service?

No, an evaluation by a psychiatrist is not required.

If an individual is given an enhanced service package is a signed agreement necessary?

A signed voluntary agreement is not mandatory. However, the cooperation of the recipient with the treatment plan is vital for enhanced services to be effective. There should be a mechanism in place for these individuals to be monitored in a similar manner to that of AOT cases.

Once it has been decided that an AOT order will be pursued, when does the clock start ticking?

Once the physician has interviewed the subject, a petition must be filed within 10 days of that psychiatric evaluation.

At what point in the process should Mental Hygiene Legal Services (MHLS) be involved?

The subject of the petition has the right to be represented by counsel (either MHLS or a private attorney, at the person’s own expense) at all stages of the proceeding. The law does not require that MHLS be involved prior to the actual filing of the petition. Each LGU (local governmental unit) needs to determine what is in the best interest of the client. Some counties have worked out a procedure where MHLS is invited to attend the physician interview with the client. This is not required, but may serve to eliminate issues that MHLS might raise regarding its ability to properly represent its client.

During a psychiatric evaluation, can the MHLS attorney instruct the subject not to answer questions?

No, the MHLS attorney cannot instruct the patient not to answer questions. The psychiatric evaluation is a mandatory procedure cited in the legislation and MHLS cannot oppose this aspect of the law. In fact, should the MHLS or private attorney attend the psychiatric evaluation of the subject, that attorney is there strictly as an observer and may not take any active role in the meeting.

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