Pittsburgh-area courts have a new tool for people in mental health crisis: the power to order treatment instead of incarceration or hospitalization.

Between 2015 and 2022, more than 5,000 people a year were evaluated for involuntary hospitalization in Allegheny County, and roughly 3,700 were committed. Fewer than half got follow-up outpatient care afterward, and 20% died within five years of that first evaluation. These deaths often trace to more than psychiatric illness – untreated medical conditions, substance use, unstable housing, poverty and limited care access all raise mortality risk too.

Assisted outpatient treatment is a shift from the county’s existing process for mental health crises, known as a 302 commitment.

A 302 is Pennsylvania’s process for involuntary emergency psychiatric evaluation and short-term hospitalization. Someone with firsthand knowledge – a family member, clinician or other person – can petition, describing behavior showing the person is a danger to themselves or others due to mental illness.

In Allegheny County, a mental health delegate typically authorizes the petition, though police or physicians can act directly in some cases. Once authorized, a physician examines the person and decides whether to admit them. If admitted, they can be held up to 120 hours. Extending treatment beyond that requires a separate court hearing. The process doesn’t require any follow-up care after release.

Not everyone qualifies for assisted outpatient treatment. To meet Pennsylvania’s criteria, a person generally must have a serious mental illness that significantly impairs daily functioning. Or they must have a history of repeated hospitalizations, incarceration or behavioral health crises and difficulty staying engaged in voluntary treatment.

I study poverty, mental health and access to social services among vulnerable populations, with a focus on racial justice and health equity, and I know that asking whether someone meets that bar is only the first question. What happens next depends on whether the services their plan calls for actually exist and are accessible. That’s not always........

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