Disability Rights California (Op-Ed): Forcing treatment on people with severe mental illness is not the answer for Sacramento

Latest News

Disability Rights California (Op-Ed): Forcing treatment on people with severe mental illness is not the answer for Sacramento

Original article published in The Sacramento Bee 

Author: Leslie Naper

The Sacramento County Board of Supervisors recently voted unanimously to implement Assisted Outpatient Treatment as of July 1, 2021. As a mental health and peer advocate, I am opposed to AOT as it is an unnecessary, expensive and discriminatory system that is inconsistent with the recovery model of mental health. It is also contrary to the peer movement, which is against forced or coercive mental health treatment practices, whether voluntary or involuntary.

Prior to the vote, Sacramento County’s Division of Behavioral Health, Mental Health Board and Mental Health Services Act Steering Committee engaged the community in discussions regarding AOT. The difficult AOT discussions were thoughtful, passionate, frustrating, triggering and heartfelt. Community members on both sides of the issue shared their personal stories with great vulnerability. 

What came across loud and clear in the discussions were the stories of losing a loved one because of an untreated mental illness. I agree that there are significant gaps in our general mental health delivery system. However, AOT is not a panacea to address the gaps in our county’s mental health delivery system or strengthen engagement and re-engagement strategies for my peers who are hard to reach, homeless or also diagnosed with substance use.

AOT undermines the Board of Supervisors’ commitment to race equity. The data provided from California counties with an AOT program show that white people are more likely to be served through “voluntary” AOT services while Black people are three times more likely to be subject to court-ordered mental health treatment — or left in jail or a locked psychiatric facility.

I am also concerned about the stigma attached to people living with serious mental illness. Just consider the language at the Board of Supervisors meeting when they voted for AOT on May 18, 2021. Every time I heard someone refer to potential AOT clients as “those people,” “nuts” and the “accused” I cringed. This is how they think of me and my peers? If you talk about us with such derogatory language, how can we trust that you will ensure we receive the best care?

Although I am well now, there was a time when I fit the criteria for AOT. But because I am Black, I would most likely be court-ordered to an AOT program if considered at all. My resistance to treatment services was not so much my lack of insight, but because of the stigma associated with having a mental health disability.

Due to stigma in media, derogatory language and attitudes along with the lack of culturally reflective and responsive services, I had little understanding of how to engage with the best services. The same holds true for many of my peers, who will now be potential AOT clients as of July 1 in Sacramento County.

It took a Full-Service Partnership Personal Service Coordinator who looked like me and shared similar lived experiences to motivate me to seek wellness, all without AOT. Full-Service Partnership invested in my wellness and recovery, used strength-based practices, included me in decisions about my treatment, had strong re-engagement practices and created paths for me to get involved as a peer to empower others. 

Sacramento’s implementation of AOT must include transparency, peer-involvement and accountability.

The law requires that counties implementing AOT must provide those same services to all mental health consumers. These services include outreach and re-engagement, culturally reflective and responsive services, family support and consultation services, peer support, client-directed services using recovery principles, mobile services, education, job training and permanent, supportive housing. If those same services were truly available, a court-ordered threat would not be necessary.

As a peer advocate with Disability Rights California, I encourage our county to follow the safeguards listed below:

  • Transparency: All decisions regarding the AOT program should be made with opportunities for stakeholders to give input. 
  • Peer-involvement: Mental health consumers and people with lived experience with forced treatment should be included in the decision-making process. We must also create pathways to serve family member and caregivers better.
  • Program review: External stakeholders should regularly review the program to ensure equity and cost-effectiveness.

As Sacramento County considers a re-design of mental health services, I am hopeful we will include a deeper commitment to the provision of community-services based on a recovery model and predicated on empowerment — services that inspire recovery without court intervention.