Lawmakers hear testimony on assisted outpatient treatment bills modeled on Jackson County pilot

Representatives Carolyn Katon and Crossley presented HB 3,313 and HB 2,088, saying the bills create a statutory framework for assisted outpatient treatment (AOT) targeted at adults with severe mental disorders who repeatedly refuse treatment and who are at high risk of hospitalization, deterioration or serious violence.

"Our legislation creates a clear standalone assisted outpatient treatment framework in Missouri," a sponsor said, describing AOT as a court-ordered involuntary outpatient plan that preserves due process: respondents would receive counsel, may request a jury, present evidence, and could appeal.

Multiple witnesses — including a pastor with a family history of mental illness, a Jackson County judge, public-administration and hospital clinicians — testified in support and described the county pilot. Judge Mark Stiles Jr. said AOT provides court oversight and frequent judicial contact with participants, which he said helps engagement and accountability. He and other witnesses said the pilot has reduced repeated hospitalizations and jail cycles and that AOT can fill a gap between inpatient commitment and voluntary outpatient services.

"What AOT does, it allows that provision. It allows a warrant to be issued and that person brought back to the court ... failure to comply, it goes back to hospitalization," Judge Mark Stiles Jr. said, describing enforcement tools included in the program.

Public administrator John Killian and clinical witnesses described difficulties created by reduced state hospital beds, placement shortages and long waits for psychiatric beds. Witnesses said AOT is intended to use existing resources — case managers, community mental-health providers and courts — rather than create a large new bureaucracy, though legislators asked for data on costs and the number of people who might participate.

Committee members pressed about due process, jury timelines in rural counties, how warrants or enforcement would be executed, and what funding or capacity would be required. Sponsors and witnesses said the bill offers a framework the counties may adopt and that language about timelines (for example, hearings within two days) can be adjusted to reflect local practice when juries cannot be impaneled immediately.

The committee received broad support testimony from clinicians and provider organizations and then concluded testimony on the bills.