By Leah Ida Harris
This article was originally published by Truthout
Patients describe serious harms, including high coercion and a systematic lack of due process.
Involuntary psychiatric treatment is a cornerstone of Donald Trump’s mental health policy, and liberal governors like Gavin Newsom, Kathy Hochul, and Wes Moore have also increasingly embraced coercive approaches to mental health care. Yet a central question often goes unaddressed by the lawmakers putting forth these policies: What happens when we force people to accept psychiatric care via court order?
In 1999, New York State enacted “Kendra’s Law,” named for Kendra Webdale, who was pushed to her death in the subway by an individual diagnosed with schizophrenia who had repeatedly sought care on his own accord and was turned away. It was the first statute of its kind establishing involuntary outpatient commitment, which establishes a regime of civil courts to mandate treatment in the community, which can include housing and other supportive services. “Assisted outpatient treatment,” or AOT, is now on the books in 48 states and the District of Columbia. As noted in a recent Government Accountability Office (GAO) evaluation of the program, AOT is governed by state law and statutes are “highly variable” from state to state. Moreover, as AOT is generally implemented on the county level, further variability may be found within states.
According to the report, more than 36,000 AOT petitions were filed from the time of the law’s inception to February 2025. Only 4.4 percent of those petitions were denied. For program funding to be re-authorized, the New York legislature requires periodic independent re-evaluation. The newest study of AOT, released in July 2026, underscored several prior research findings — namely, that court orders add no benefit over voluntary access to housing and community care, while causing significant harm to participants. In addition, researchers documented an alarming lack of due process through dozens of qualitative interviews. The program also displays clear racialized bias: As Sakeena Trice from New York Lawyers for the Public Interest wrote, “The evaluation shows a system that does not outperform voluntary care, falls disproportionately on Black New Yorkers, and inflicts real, documented harm.”
As Politico phrased it, the nearly 400-page report had a “quiet release ” on the Office of Mental Health’s website. Researchers who worked on the report allege that the Office of Mental Health “spun” the report’s key conclusions, arguing that officials overstate the success of AOT — for example, by pointing to reductions in hospitalization and improved housing stability that could also be achieved without a court order —while downplaying the disturbing outcomes documented in firsthand accounts.
When given an opportunity by Truthout to reply to these allegations, a representative from the Office of Mental Health sent this statement in response:
All of the comments made by OMH on the report speak directly to the data provided by the evaluation. Our conclusions are quantitative, verifiable, and well-supported by this complex evaluation of a multifaceted program. We will use this evaluation as appropriate to continue improving assisted outpatient treatment in New York, along with input from key stakeholders across the state.
In this exclusive Truthout interview, we speak to Dr. Nev Jones, whose team at the University of Pittsburgh’s PathLab was a co-lead investigator on the evaluation. Jones, who is open about her own lived experiences of psychosis, discusses why she and fellow researchers are fighting back now.
The interview that follows has been lightly edited for clarity and length.
Related Story
<div class="before-headline d-none d-md-block mt-auto mt-md-0 mb-2 fs-12 d-inline text-uppercase font-sans text-decoration-none black-65">
News |
<div class="ar__section d-inline"><a href="https://truthout.org/section/prisons-and-policing/" rel="section" class="ar__section__link prisons-and-policing text-decoration-none black-70">Prisons & Policing</a></div>
<h2 class="in-rel__con__ti" itemprop="headline"> <a href="https://truthout.org/articles/massachusetts-advocates-resist-dystopian-involuntary-outpatient-commitment-bill/">Massachusetts Advocates Resist Dystopian Involuntary Outpatient Commitment Bill</a></h2> <div class="in-rel__sum ar-list__sum d-none d-md-block mb-1 fs-12" itemprop="description"> Massachusetts is now one of only two states that don’t use specialized courts to mandate forced psychiatric treatment. </div> <div class="ar-list__meta d-none d-md-block mb-auto"> <!-- components/authors --><dl class="byline list-inline font-sans d-inline mt-2 mb-0 black-70"> <dt class="byline__label d-inline me-0">By</dt> <dd class="byline__author author vcard d-inline me-0" itemprop="author" itemscope itemtype="https://schema.org/Person"> <span class="byline__author__name" itemprop="name"> <a class="byline__author__link url fn text-decoration-none black-70" href="https://truthout.org/authors/leah-harris/" itemprop="url" rel="author">Leah Ida Harris</a> </span> <span class="separator">, </span> </dd> <dd class="byline__source source org d-inline" itemprop="sourceOrganization" itemscope itemtype="https://schema.org/Organization"><span class="byline__source__name text-uppercase" itemprop="name"> <a class="byline__source__link text-decoration-none d-inline black-70" href="https://truthout.org" itemprop="url"><span class="byline__source__upper">T</span>ruthout</a></span></dd> </dl> <time class="published updated meta-data visually-hidden" datetime="2025-11-26T15:44:15+00:00" itemprop="datePublished dateCreated" content="2025-11-26T15:44:15+00:00">November 26, 2025
Leah Harris: Office of Mental Health Commissioner Ann Sullivan penned an op-ed characterizing AOT as “a last resort for a very small group of individuals experiencing serious mental illness,” saying that it’s “not a decision reached lightly.” The “last resort” trope has often been restated in media coverage as well. What is the problem with this framing?
Nev Jones: Sadly, not just in AOT, so-called “last resorts” involving force and coercion are virtually never that. Once a system introduces and then normalizes the machinery enabling control through coercion rather than relationship, or fellowship in the original sense of a comrade or partner in a shared undertaking, it almost inevitably grows in use.
Top-down force is always easier than the slow, non-linear work involved in building relationships, and ultimately, trust. And in systems that are chronically under-resourced and under-funded, in which moral injury and compassion fatigue are ubiquitous, exhausted providers are indeed going to turn to it — certainly not only as a “last resort.”
The “last resort” argument also falls apart in places where the wait list for intensive voluntary services like Assertive Community Treatment, or ACT, comparable to AOT (but without the court order), is up to one or two years, or more. Providers who have no other way of getting a client a Section 8 housing voucher or place on a community treatment team are likely to realize that AOT can achieve this. They’re going to take the Faustian bargain, not because the client is “non-adherent” or “violent,” but because they desperately need access to services or supports. As one provider we cited in the evaluation said, “The easiest way to get someone in treatment is to do [an] AOT order. ACT is a waiting list.” We met many such providers.
What harms do you think public officials’ responses to the report have minimized, and what prompted you and your team to speak out?
When it comes to policy like AOT, the stakes are not small. As we documented in our evaluation, numerous participants described serious harms, including high coercion and a systematic lack of due process.
Our study found that hospital discharge “ultimatums” were a common pathway of AOT initiation, with 65 percent of respondents describing some form of coerced agreement that would allow them to return to the community. As one participant we interviewed said, “AOT is literally probation: They say, ‘Okay, you can get out of jail, but do this, this, and this, or we’ll send you back to jail.’ It’s very depressing, and I hate it.”
Other participants found court orders renewed on what felt like an indefinite basis, even when they had fully complied. “It feels like a forever sentence,” according to one respondent.
Some people we spoke to literally broke down when describing their experiences. We also had two participants who felt so harmed they were planning to leave the United States and return to their countries of origin. These are simply not minor, dismissible impacts. The minimization of acceptance and responsibility is both deeply sad and, from a moral perspective, demands visible, public contestation.
And the report doesn’t even capture some of the system-level harms we observed. For instance, we observed sometimes intense stigma, evident in the way administrators and legal staff talked about individuals on AOT orders. Internally, members of the evaluation team frequently likened it to talking about this group as if they were “animals” or “less-than-human.” None of this signals policy that protects dignity and rights. Instead, it seems to be reinforcing the very worst stereotypes folks might have about “schizophrenia” or “serious mental illness.” So if the goal is to do justice to what people told us and their concerns raised, it’s incumbent on us to insist that these concerns not just be pushed to the side, buried or sidelined.
Or to put it very simply: We owe it to those directly impacted to take what they’re saying seriously. We owe it to them to be honest and truthful about the very significant limitations of quantitative data available, to be honest and truthful about the extent to which such limited administrative data cannot and will not ever capture the actual experience of AOT, its mechanisms of action, its complex and multiple impacts.
What was your expected response to your team’s independent evaluation? What has surprised you about it?
We expected that entities with a strong ideological commitment to AOT would try to either discredit or minimize our critical findings, especially findings stemming from our qualitative work concerning harm and due process failures. But I nevertheless expected more along the lines of, “This is not okay — and we need to take these concerns seriously, commission further work, take concrete steps to understand how widespread some of these harms are, critically examine what’s happening with court processes across the State.” That demonstrates a willingness to take concerns seriously; even the next step would be “more data is needed.”
What we so desperately need — not just in New York but across the U.S. — are public servants with the humility to admit when they or their policies are problematic or harmful, and then embracing the real work of social change. For example, investing in an authentic community engagement process with the goal of listening to, learning from, and validating individuals and communities who have been harmed, and then collaboratively developing a reparative plan. Denial and minimization instead operate precisely as the testimonial erasure that the psychiatric disability community has endured for so long — that is, no matter what those directly impacted report about their experiences, it is discredited and minimized.
I’m also not surprised but certainly disappointed by the silence of the state’s peer advocacy division, which is supposed to support disability and civil rights. Dr. King’s famous line — “In the end we will remember not the words of our enemies, but the silence of our friends” — has been running through my head since the report was released. What is “advocacy” without the courage to speak truth to power — especially when you are in the firing line? How did some of us drift so far from the actual goals of early psychiatric patients’ liberation movements, caving in entirely to the seduction of buddying up to the powers that be?
What else do think the public needs to understand about Assisted Outpatient Treatment and its implementation?
One thing the public report really does not do justice to is the often really alarming attitudes we heard in consultations or interviews with a not insignificant number of providers, administrators, and legal system staff. Stuff that raises all kinds of concerns about the extent to which the implementation of Kendra’s Law reinforces, rather than undermines, discrimination and prejudice toward individuals labeled with serious mental illness.
For instance, senior, high-level leaders in various domains told us things like, “It’s only a matter of time before schizophrenics rape or kill”; repeatedly told us that we simply “don’t understand how dangerous these people are”; and presented rationalizations such as, “Why would I even consider a less restrictive alternative, when any one of them could be the next subway pusher, and who wants to be responsible for that?” Several officials asserted to me, with total confidence, that without forced medications, the brains of “schizophrenics” inevitably deteriorate [a scientific falsehood]. At times it was too hard for more vulnerable junior members of the team to even sit through these conversations and they had to bow out. That is to say, even in our conversations about AOT, there could be so much othering, so much dehumanization, so much harm. So sure, the average rate of hospitalization goes down, but what are we really doing here? Is this what we really think a healing-oriented system does?
Disclosure: Leah Harris formerly worked with Dr. Jones, and was affiliated with PathLab as a part-time research coordinator, but did not have a role in the New York evaluation.
This article was originally published by Truthout and is licensed under Creative Commons (CC BY-NC-ND 4.0). Please maintain all links and credits in accordance with our republishing guidelines.