Senate committee advances four bills to expand assisted outpatient treatment and mediation for mental illness

The Senate Committee on Health Policy on March 19 voted to report four bills — Senate Bills 219, 220, 221 and 222 — to the Senate floor with recommendations that they pass. The bills would expand access to assisted outpatient treatment by widening who may testify about a person’s need for AOT, increase use of mediation, allow AOT as a misdemeanor diversion in some cases and enable family members to petition for extensions of existing orders.

Judge Milton Mack, a retired probate judge and chair of the governor’s Mental Health Diversion Council, told the committee the bills are meant to “build on that success and remove barriers in order to maximize the use of assisted outpatient treatment as an alternative to hospitalization.” He said Michigan’s mental health code now permits family members to petition for outpatient treatment before hospitalization and argued the bills would make that option more practical in many counties where psychiatrists are scarce.

The legislation would add physicians, psychologists and psychiatric nurse practitioners or physician assistants working under psychiatrist supervision to the list of clinicians who may testify to a probate court about the need for AOT; a psychiatrist would still supervise preparation and implementation of any ordered AOT plan. Judge Mack said the current statute’s psychiatrist-only testimony requirement has made AOT petitions rare: “less than 5% of the petitions for treatment filed in Michigan at this time are for AOT only,” he said. He also said counties that have embraced outpatient alternatives have seen reduced hospitalizations and jail time; he cited Genesee County, where hospitalization has fallen “by as much as 70 percent.”

Senate Bill 220 would broaden the use of mediation for disputes over treatment, allowing providers to pursue mediation rather than immediately filing court petitions when a patient is noncompliant. Marianne Hough, a clinical social worker and board member of the Mental Health Association in Michigan, supported the bills and told the committee AOT and mediation could increase early intervention: “If we can find ways to get somebody treatment before they’re the point of considering, you know, looking at harm to self or others … AOT is a great tool,” she said.

Senate Bill 221 would permit voluntary use of AOT as an alternative to forensic evaluation 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 — not only providers — to petition for extensions of existing involuntary treatment orders, addressing lapses when providers forget to file extension requests.

Committee members did not request amendments during the hearing. The clerk recorded unanimous 10-0 votes to report each bill to the floor with the recommendation that the bill pass. Motions were made by committee members: 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). Each bill’s roll call in committee recorded 10 yeas and 0 nays.

Support for the package was noted in submitted testimony and cards from multiple organizations, including the Michigan Health & Hospital Association, Disability Rights Michigan, PAAM and the Community Mental Health Association of Michigan.

If enacted, the measures would change who may initiate and attest to outpatient treatment orders and broaden nonjudicial avenues for resolving treatment disputes. No final floor action was taken at the committee meeting; each bill was merely reported out of committee for further consideration by the full Senate.