The reality of accessing mental health care is such that the majority of services are provided to individuals in a community or outpatient setting. In Illinois, there are two common conduits for outpatient care: involuntarily or through an agreed care and custody order. Outpatient admission can be sought as a stand-alone remedy for an individual residing in the community already, or for someone who is inpatient at a mental health facility (whether voluntary or involuntary). Moreover, if a petition for inpatient admission is filed, a petition for admission on an outpatient basis “may be combined with or accompanied by a petition for involuntary admission on an inpatient basis.”

Under the Mental Health and Development Disabilities Code, “[a]t any time before the conclusion of the hearing and the entry of the court’s findings, a respondent may enter into an agreement to be subject to an order for admission on an outpatient basis.” This provision allows for a respondent and his or her counsel to resolve a pending petition (inpatient or outpatient) with a settlement agreement that contains specific terms of outpatient treatment.

Although state law establishes the criteria respondents must meet to qualify for outpatient admission, local policy, priorities, and even a lack of understanding of legal processes often influence whether the mechanism is incorporated in a particular jurisdiction’s toolbox of mental health interventions.

Recommendation 6.2 of the Illinois Mental Health Task Force Action Plan seeks to increase the use of civil pathways to outpatient care, which is often referred to as Assisted Outpatient Treatment (AOT). In general, AOT refers to involuntary mental health treatment in an outpatient setting with varying degrees of judicial involvement and oversight.

In Illinois, 405 ILCS 5/1-119.1. establishes the parameters of whether someone meets the criteria for an outpatient admission as follows:

(1) A person who would meet the criteria for admission on an inpatient basis as specified in Section 1-119 in the absence of treatment on an outpatient basis and for whom treatment on an outpatient basis can only be reasonably ensured by a court order mandating such treatment;

or

(2) A person with a mental illness which, if left untreated, is reasonably expected to result in an increase in the symptoms caused by the illness to the point that the person would meet the criteria for commitment under Section 1-119, and whose mental illness has, on more than one occasion in the past, caused that person to refuse needed and appropriate mental health services in the community.

Thus, by definition, the standard afforded to outpatient admission is a lessor threshold than the criteria applied for inpatient admission.

As the Illinois courts and justice partners work to implement Recommendation 6.2, several educational activities have taken place. A 6-part Civil Mental Health Proceedings Training Series is now available on the Illinois Supreme Court Judicial College’s Learning Management System. Secondly, to engage a wider audience of justice partners, the AOIC Statewide Behavioral Health Administrator and Judges from the Special Supreme Court Advisory Committee for Justice and Mental Health Planning, and the Illinois Psychiatric Society (IPS) have recently facilitated training sessions at the IPS Annual Conference and the Annual Conference of the Illinois Association of Medicaid Health Plans. Current discussions are underway to schedule educational seminars with the Illinois State Bar Association’s Mental Health Law Section, National Alliance on Mental Illness (NAMI) of Illinois, the Illinois Association of Behavioral Health, and the Illinois Health and Hospital Association to name a few.

Furthermore, with 47 states establishing AOT statutes, as expected, some states are more successful than others in implementing and operationalizing the law. According to the Treatment and Advocacy Center, “Illinois is one of only 17 states that provide access to treatment on the basis of need, in addition to considerations of dangerousness. Illinois’ laws also allow for the use of court-ordered treatment in the community.” In its 2020 Report titled “Grading the States: An Analysis of Involuntary Psychiatric Treatment Law,” the Treatment and Advocacy grades the quality of Illinois Involuntary Admission statutes as a B –.

In an effort to determine how other states have achieved higher “grades” and have been more active in operationalizing outpatient admission laws, the University of Illinois-Chicago School of Law has approved an Independent Study opportunity in its Law and Mental Health Policy course and awarded a student the opportunity to complete a comparative analysis of specified state statutes and subject matter expert interviews, to produce a report outlining implementation barriers and opportunities in Illinois.

Finally, the courts, the University of Illinois Hospital and Health Sciences System, and the Illinois Department of Human Services recently convened a half day workshop including stakeholders from the bench and bar, as well as law enforcement, emergency medicine, inpatient mental health units, community mental health providers, and advocates for persons with lived experience to create a systems map to highlight the outpatient admission process and role of each specified process actor. The session was facilitated by the University of Illinois Chicago’s Institute for Healthcare Delivery and Design and supported by the Otho S. A. Sprague Memorial Institute.

PETITION FOR INVOLUNTARY OUTPATIENT ADMISSION: DHS Form IL 462-2210