Senate committee advances 4-bill package to expand assisted outpatient treatment and mediation

The Senate Committee on Health Policy on March 19 voted to report four related bills — Senate Bill 219, Senate Bill 220, Senate Bill 221 and Senate Bill 222 — to the full Senate with a recommendation that each bill pass.

The package would expand use of assisted outpatient treatment (AOT), permit broader professional testimony when courts consider outpatient orders, expand the use of mediation to resolve treatment disputes, allow AOT as an option for certain misdemeanor defendants and enable petitions for continuing treatment before current orders expire.

Judge Milton Mack, a retired probate judge who serves as chair of the Governor's Mental Health Diversion Council, told the committee the bills are intended to allow more timely intervention and reduce avoidable hospitalizations and jail stays. "Mental illness is treatable and recovery is possible," Mack said, summarizing findings of Michigan's Mental Health Commission and arguing that earlier outpatient treatment can prevent crises. Mack said one obstacle is the current requirement that a psychiatrist testify to the need for AOT; he told the committee that less than 5% of current petitions are for AOT only because it is difficult to secure psychiatrist testimony.

Under the changes described by Mack: Senate Bill 219 would add other clinicians — a physician, psychologist, psychiatric nurse practitioner, or a physician assistant working under a psychiatrist's supervision — as people who could testify that AOT is needed. If a court orders treatment, Mack said, a psychiatrist would still supervise the preparation and implementation of the AOT plan. Senate Bill 220 would expand the use of mediation so providers could seek mediated agreements instead of immediately filing petitions for involuntary treatment. Senate Bill 221 would create a voluntary pathway to use AOT as an alternative to sending a misdemeanor defendant to a forensic center for competency assessment when both prosecutor and defendant do not object. Senate Bill 222 would allow family members, not only providers, to petition for extensions of assisted outpatient treatment orders when providers fail to file on time.

Marianne Hough of the Mental Health Association in Michigan, a clinical social worker who said Judge Mack serves on the association's board, told the committee she supports the bills and urged broader awareness of AOT as a tool for early intervention. "If we can find ways to get somebody treatment before they're the point of considering harm to self or others ... AOT is a great tool," Hough said.

Support letters filed with the committee included the Michigan Health and Hospital Association, Disability Rights Michigan, PAAM and the Community Mental Health Association of Michigan; several listed in the record did not wish to speak.

Votes at a glance

- Senate Bill 219 (expand who may testify in AOT proceedings): reported to the floor, vote 10-0 (yeas 10, nays 0). Motion to report moved by Senator Santana. - Senate Bill 220 (expand mediation options to reduce petitions): reported to the floor, vote 10-0. Motion to report moved by Senator Bueno. - Senate Bill 221 (permit voluntary AOT as alternative to forensic evaluation for some misdemeanors): reported to the floor, vote 10-0. Motion to report moved by Senator Cherry. - Senate Bill 222 (allow family petitions to extend AOT orders): reported to the floor, vote 10-0. Motion to report moved by Senator Kleinfeld.

Committee members recorded by the clerk as voting yes on each bill were: Chairman Cameron Hertel; Senator Santana; Senator Bueno; Senator Cherry; Senator Kleinfeld; Senator Geiss; Senator Weber; Senator Hauck; Senator Huizenga; Senator Runstead.

Advocates and the bill sponsor(s) said the measures are intended to increase early access to outpatient care and reduce reliance on inpatient beds or incarceration. Judge Mack told the committee that jurisdictions that have embraced AOT and earlier outpatient interventions have reported substantial reductions in hospitalizations and jail time; he cited Genesee County as an example where hospitalization fell "by as much as 70 percent" where community AOT practices have been used.

No committee member questions or amendments were recorded during the testimony; the committee moved directly to votes after hearing the testimony and reading supportive cards.

The bills will now proceed to the Senate floor with committee recommendations that they pass. Committee minutes and the clerk's roll calls are part of the official record.