In February, the Treatment Advocacy Center (TAC-not funded by drug companies) hired Health Management Associates (HMA) to examine and report on cost findings in seven jurisdictions that use Assisted-Outpatient Treatment (AOT). The study also noted any sources of cost savings common among the sites.
Potential reductions in direct cost can be extrapolated and include:
mental health treatment costs, including inpatient and outpatient psychiatric services
hospitalization to provide non-psychiatric medical services
outpatient services for non-mental health issues
administrative costs for serving the individuals, including any civil commitment court costs
Indirect costs that could be seen elsewhere include:
shelter costs (homeless housing/housing supports)
criminal justice costs (public safety costs to arrest and book offenders, jail services, public defender costs, districtattorney costs, and court costs)
The sites surveyed were Summit County, Ohio (with Akron) and New York (with New York City's five boroughs and five additional jurisdictions.)
The summary of per person AOT cost savings is as follows:
New York City saw a reduction in costs of 47%. The outlying five counties had a 58% decrease in cost. Summit County had a 50% savings rate.
Assisted-outpatient treatment or AOT is court-ordered treatment for individuals with schizophrenia who, by virtue of their treatment patterns (revolving in and out of the hospital, becoming violent or getting incarcerated or being
homeless), become a risk when unmedicated.
One specific takeaway about individuals who often require AOT:
Upwards of 50 percent of the people diagnosed with schizophrenia have a symptom,
anosognosia, that is the lack of awareness that you have an illness. Since they don't think they're sick they stop taking the medication as soon as
they get out of the hospital. Then they get sick again and go back into the hospital: the "frequent flier" syndrome.
Xavier Amador, PhD interview part one
Xavier Amador, Phd interview part two
about helping a person with anosognosia get and stay in treatment.
Legal cases involving people with schizophrenia who were unmedicated:
Forcing a psychotic woman to have an abortion