It’s the season for thank-you notes, as we contemplate gifts given and received.
Allegheny County just gave a wonderful gift this year to me and families like mine. In 2026, the county is going to opt into the newest provision of the Mental Health Procedures Act: We’re going to try using assisted outpatient treatment (AOT). You know that one gift you wanted so much but feared you’d never get it? For me, it’s this.
Severe mental illness became a key part of my family’s life in 2012, when my oldest son, Levi, was diagnosed. There’s treatment and it’s effective, and in his case, the second medicine worked like a charm. But before he went into the prison system in 2013, we couldn’t benefit from any treatment at all. To put up with taking medicine, you must believe that you need it, and he was sure he did not need it.
Nearly everyone with paranoid schizophrenia (and many with severe bipolar disorder) experiences a key symptom of brain disease: They can’t tell anything is wrong. Imagine if your skin turned green but your own eyes literally could not see it, or if you shouted all the time but your own ears could not hear it. The part of the brain that notices a problem is paralyzed or broken by the disease. It’s called “anosognosia,” which means the inability to know your own mind.
In 2018, the state created an option for counties to use civil (not criminal) orders to tell people experiencing anosognosia they really do need to treat a problem. An assisted outpatient treatment civil order not only tells the patient they must cooperate, it also tells the county they must provide as much assistance as that person needs.
An AOT order mandates that this person is not allowed to fall through the cracks. That is the most wonderful sentence for any family member to read. Those homeless people, the inmates and the crazy ones in the ER, those people are our sons and daughters. Without AOT, the law tied our hands, forcing us to watch them fall through those cracks.
I know Allegheny County got a lot of pushback about creating an AOT program. Some worry it will be expensive, and others that it will violate people’s rights. I understand these concerns, but if you’ve stood where I stand, you see the other side. With an AOT program, there is some sliver of hope that maybe this time things will get better before tragedy strikes. Maybe we can preserve their most precious right: to live with a whole mind.
Thank you, Allegheny County. Thank you to all of the professionals who spoke up to support adopting this program. Thank you to the administrators who are taking a deep breath and saying, “OK. Let’s do something new.”
Happy New Year, and thank you from all the families!
Ruth Johnston of Gibsonia is founder of AOT for Allegheny County (aotforalleghenycounty.com/).
