The Massachusetts Administrative Office of the Trial Court (AOTC) in partnership with Boston Medical Center (BMC) is applying for a $4 million SAMSHA Grant over the course of 4 years to design, develop, implement and evaluate a new program in the Boston Municipal Court to provide the first demonstration of Assisted Outpatient Treatment (AOT) in MA with seriously mentally ill (SMI) and criminally involved patients in need of more comprehensive and intensified services than are currently available. The population of focus includes patients who refuse to participate in our three mental health courts (MHCs), those who are ineligible for MHC due to the nature of their offenses, and those who have been involved with the MHC who have relapsed or require aftercare—patients frequently caught in a “revolving door” of repeated psychiatric hospitalizations. We expect BOAT patients to resemble clients of the MHCs—who are 48% Black and 17% Latinx. Their main diagnoses are psychotic disorders (40%), major depression (34%), and anxiety (15%). More than two-thirds reside with family members (36%) or on the street (35%). More than half (53%) have co-occurring SUDs, and (72%) are male.
Our geographic service area is Boston Massachusetts, home to 694,583 residents in 2018. Although Massachusetts does not provide for AOT by way of legislation that allows for a civil involuntary commitment order, judges do have legal authority to order a person with SMI to participate in mental health treatment and maintain their recovery on an outpatient basis within the community. M.G.L. c. 276 sec. 87 provides for the imposition of terms of probation that enable a criminal defendant to remain in the community under the supervision of the court with conditions that he or she adhere to prescribed mental health and /or substance disorder treatment services. The goals and objectives of AOT are thereby satisfied. The BOAT Program will serve 75 patients in Year 1 and 100 each year thereafter, for a total of 375 patients over four years.
BOAT patients will be assessed and treated by a multidisciplinary care team—the BOAT psychiatrist and a mental health clinician, case manager, peer specialist, recovery coach, and employment specialist. In addition, all patients will be referred to fully integrated primary care practices within BMC or one of the hospital’s 14 affiliated community health centers (CHCs), all of which offer master’s level counseling, psychiatric clinic sessions, and medication for addiction treatment. Within BMC, care coordination will be facilitated through our electronic health record and existing relationships with the CHCs.
After a 90-day period of intensive outpatient services, patients will be transitioned to a “stepdown” outpatient program, and thereafter, to one of our integrated primary care practices. Monitoring, case management and support services will continue for an average 12-18 months. BOAT staff will maintain a REDCap database for the purposes of monitoring, case management and evaluation. Outcomes of interest include pre/post health-related quality of life, homelessness, arrests, psychiatric hospitalizations, employment and utilization and cost of acute care services.