Tom Burns, M.D., Psychiatrist and Professor of Social Psychiatry at Oxford, was recently interviewed by the LA Times about the implementation of Assisted Outpatient Treatment (AOT) in California. The three most populous counties, LA, SF and Orange, have now voted to implement AOT. Burns cited the main conclusion from his recent “thorough research,” based on randomized control trials, that “compulsion added to otherwise decent care makes no difference.”
His blunt assessment stands in stark contrast to E. Fuller Torrey’s web-site comments which indicate that AOT has been proven successful — “spectacularly so.” This was no easy conclusion for Burns, who for twenty years “argued ardently” for Community Treatment Orders (CTO’s), which are described as the British version of California’s newly passed AOT laws.
When asked what does work, Dr. Burns identified three components of decent mental health care;
- Providing steady, flexible, “low-grade” outreach that can go on for months or years (not exactly sure what is meant by low-grade)
- Helping to stabilize a person’s social life
- Ensuring the person gets their medication
Dr. Burns ends the interview with the following challenge about evaluating the impact of this new law. He states; “if people are going to evaluate it, then evaluate it in a way that’s sufficiently rigorous to distinguish differences in access to better treatment from the effects of compulsion.” I would urge Dr. Burns and LA program evaluators to consider another line of inquiry that seeks to distinguish differences between access to voluntary, recovery-oriented, non-pharmacentric approaches from ones that do fixate on medication compliance and treatment adherence. It appears that Burns’ scientific curiosity and imagination could not envision this bold hypothesis.
I thought of Burns’ comments in the context of The Village, a recovery model program run by the Mental Health Association in Los Angeles (which opposes AOT). The Village supports “member” choice and never requires or coerces medications. It offers long-term outreach, housing, job development and a strong sense of community and relationships. Fellow MiA author Mark Ragins practices his own unique style of collaborative psychiatry there. (Full disclosure: I worked at The Village for 19 years.) The Village focuses on helping people pursue their own goals to improve their lives, rather than concentrating on the treatment of symptoms and diagnoses.
So; the availability of potential comparison groups already exists. Does the willingness for rigorous evaluation?
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