Senate committee advances four assisted‑outpatient‑treatment bills to Senate floor

The Michigan Senate Committee on Health Policy on March 19 advanced a package of four bills aimed at expanding assisted outpatient treatment, commonly called AOT, and easing barriers to community‑based mental‑health care.

The bills — Senate Bill 219, 220, 221 and 222 — were reported out of committee by unanimous voice votes, each with a recorded tally of 10 yeas and 0 nays. Senators moved each bill to the Senate floor with a recommendation that it pass.

The package would: expand which clinicians may testify to a court about a patient's need for AOT; broaden the use of mediation as an alternative to court petitions; allow AOT as a voluntary diversion option in some misdemeanor cases; and let family members petition for extensions of continuing involuntary treatment orders that currently only providers may request.

Retired probate judge Milton Mack, chair of the governor's Mental Health Diversion Council, testified in support of the legislation and described the practical effects of the proposed changes. "The current requirement that only a psychiatrist can testify as to the need for treatment, where no psychiatrist is readily available, means we have to wait until a person is sick enough to require hospitalization before we can seek assisted outpatient treatment," Mack said. He added that when counties have embraced earlier intervention, "hospitalization has been reduced by as much as 70 percent" in one cited county.

Mack said expanding who may testify would not remove psychiatrist oversight: if a court orders treatment, a psychiatrist would still supervise the assisted outpatient treatment plan, but the bill would allow a physician, psychologist, or a psychiatric nurse practitioner or physician assistant working under a psychiatrist's supervision to provide testimony about need. Mack also told the committee that fewer than 5 percent of petitions filed in Michigan are for AOT only, a sign he said that statutory barriers limit early intervention.

Senate Bill 220 would formalize broader use of mediation so providers or family members could pursue mediated agreements before filing court petitions. Mack and Marianne Hough of the Mental Health Association in Michigan said mediation can reduce unnecessary petitions and increase treatment engagement.

Senate Bill 221 would permit AOT as an alternative in some misdemeanor cases, used voluntarily when prosecutor and defendant do not object. Senate Bill 222 would allow family members to petition for extensions of orders for continuing involuntary treatment in circumstances where currently only providers can request extensions.

Committee members asked no substantive questions after testimony and the committee proceeded to vote. The clerk recorded identical tallies as each motion was called: 10 yeas and 0 nays for SB 219, SB 220, SB 221 and SB 222. Movers on the motions were recorded in committee: SB 219 moved by Senator Santana, SB 220 moved by Senator Bueno, SB 221 moved by Senator Cherry and SB 222 moved by Senator Kleinfeld.

Supporters at the hearing included the Mental Health Association of Michigan, Disability Rights Michigan, the Michigan Health & Hospital Association, PAAM and the Community Mental Health Association of Michigan, each recorded on committee testimony cards as supporting the package.

If enacted as written, the package would change the timing and process for initiating community‑based treatment but would preserve psychiatrist supervision of treatment plans when courts order care. Committee supporters told members the bills are intended to increase earlier intervention and reduce hospitalizations and jail stays by expanding access to AOT and by encouraging mediation and diversion where appropriate.