Senate committee advances package to expand assisted outpatient treatment

The Michigan Senate Committee on Health Policy voted 10-0 on March 19, 2025, to report Senate Bills 219, 220, 221 and 222 to the Senate floor with a recommendation that they pass, after testimony from judges, advocates and treatment providers supporting expanded use of assisted outpatient treatment.

Committee action follows testimony that the bills would let families and clinicians pursue community-based treatment earlier, expand the types of clinicians who may testify about a patient’s need for AOT, and create mediation and diversion options to reduce hospitalizations and incarceration.

Judge Milton Mack, a retired probate judge and chair of the governor’s mental health diversion council, said the package is designed to “build on” earlier changes to Michigan’s Mental Health Code that permit intervention before a crisis. He told the committee that the changes would “remove barriers in order to maximize the use of assisted outpatient treatment as an alternative to hospitalization,” adding, “If we make assisted outpatient treatment more readily available, we're going to help ease the impact of that shortage of beds.”

Under the package as described in testimony, Senate Bill 219 would expand who can testify to the court about the need for AOT when a psychiatrist is not readily available. The bill would allow testimony from a physician, a psychologist, or a psychiatric nurse practitioner or physician assistant working under the supervision of a psychiatrist; a psychiatrist would still be required to supervise preparation and implementation of any AOT plan. Judge Mack said the current requirement that “only a psychiatrist can testify” has made it difficult to seek AOT early and that fewer than 5% of petitions filed in Michigan are currently for AOT only.

Senate Bill 220 would expand use of mediation so that treatment providers could pursue mediation when a patient is noncompliant, avoiding court petitions in some cases. Judge Mack and Marianne Hough of the Mental Health Association in Michigan said mediation agreements can reduce petitions, hospital stays and emergency-room use and make treatment engagement more likely. Hough said, “AOT is a great tool and I just really wanted to provide support for that.”

Senate Bill 221 would create a voluntary option to use assisted outpatient treatment as an alternative to referral to a forensic center for competency assessment in some misdemeanor cases, with dismissal of the underlying charge if the prosecutor and defendant do not object. Senate Bill 222 would allow family members to petition for extensions of AOT orders in cases where currently only providers may file for extension; testimony noted providers sometimes fail to file, which can interrupt care.

Committee members read written support from multiple organizations into the record, including the Michigan Health and Hospital Association, Disability Rights Michigan, the Psychiatric Association of Michigan (PAAM), and the Community Mental Health Association (CMHA). After testimony and questions, the committee voted by roll call to report each bill: SB 219 (moved by Sen. Santana), SB 220 (moved by Sen. Bueno), SB 221 (moved by Sen. Cherry) and SB 222 (moved by Sen. Kleinfeld). The clerk recorded 10 yeas and 0 nays on each motion.

No member voiced opposition during the hearing. Committee members asked no substantive follow-up questions after Judge Mack’s testimony; the chair thanked witnesses and moved on to the next agenda item.

The bills will proceed to the full Senate for further consideration.