Pennsylvania's Allegheny County implementing involuntary outpatient
mental health care services
[December 27, 2025]
By VENURE SIRIWARDANE/Pittsburgh's Public Source
Allegheny County will use a controversial legal tool for involuntary
mental health care in the community starting Jan. 1, according to a
letter county officials sent Tuesday to the state’s Office of Mental
Health and Substance Abuse Services. Called assisted outpatient
treatment (AOT), it’s a law that no other Pennsylvania county has been
able to successfully implement since state lawmakers voted for it in
2018.
The county developed its AOT plan based on research evidence, advice
from local and national experts, and collaboration with partners across
county government, wrote Erin Dalton, director of the county’s
Department of Human Services, in the letter addressed to Deputy
Secretary Jennifer Smith.
Dalton and other human services officials explained the county’s
reasoning during an interview Tuesday with Pittsburgh’s Public Source.
“We’ve concluded that the risks of doing nothing are higher than the
risk of trying this, and (I) think we’ve put a number of safeguards in
place” to mitigate the harm that involuntary treatment can cause, she
said.
Officials were motivated to act by “people’s calls for something at a
lower threshold of risk than danger to self or others,” Dalton added,
referring to the legal requirements for involuntary hospitalization,
known as 302 commitments. In a paper published in July, a team of
researchers — including one based at the Department of Human Services —
established a causal link between 302s in Allegheny County and harm a
person experiences after they’re discharged, including being charged
with a violent crime and dying of suicide or overdose.
They don’t want “to wait and watch their loved ones decompensate in that
way or wait for something more challenging to happen.”
The county will establish an advisory group to monitor implementation
and review progress through 2026, according to the letter. Confirmed
members include a former U.S. Attorney for the Western District of
Pennsylvania, the director of a local court watch program, an
unidentified psychiatrist, two academic experts, a disability rights
attorney and the director of a major provider of shelter services in the
county.
One member, Nev Jones, an associate professor of social work at the
University of Pittsburgh and one of the fiercest critics of the county’s
AOT plan, said she’s “not surprised” by the county’s decision to
implement the law. She pointed to a nationwide shift in recent years
toward strengthening involuntary mental health practices, compounded by
an executive order issued by President Donald Trump in July that aims to
institutionalize unhoused people who have mental illnesses, substance
use disorders, or both.
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 The announcement follows a lengthy
stakeholder engagement process, driven in part by a Public Source
investigation this year of involuntary treatment here and in other
jurisdictions. Almost exactly a year ago, the county quietly
informed the state that it would implement the state’s AOT statute
by Sept. 1. After an inquiry from Public Source in April, officials
from the county’s Department of Human Services said the county was
“still in exploration” and hadn’t made a decision yet.
At the time, news of the county’s interest in AOT inspired hope
among the law’s advocates — including some family members of people
with serious mental illness — who had long pushed for more forceful
intervention to help those who resist treatment before they reach a
crisis point.
And it triggered outcry from critics of AOT, including clinical and
academic experts who said involuntary care can destroy a patient’s
trust in the public mental health system and has serious
implications for the civil rights and individual autonomy of some of
the most vulnerable people in the county.
The county’s initial Sept. 1 deadline passed as it continued to
engage with stakeholders and convened a working group that included
officials across county government, including the Court of Common
Pleas, the Office of the Public Defender — which will represent
those facing AOT petitions — and others. It also consulted with
officials from other jurisdictions with existing AOT programs,
including those in California and New York state, which enacted the
nation’s first AOT statute, Kendra’s Law, in 1999.
AOT is a legal mechanism for involuntarily treating people with
serious mental illness without hospitalizing them. The law states
“any responsible party” can file an AOT petition, which starts a
civil court procedure. During a hearing, a judge may order a person
to undergo treatment in the community, which typically includes
psychiatric medication, but can also include therapy and other
wraparound services. The statute bars courts from holding someone in
contempt or issuing penalties for not following their treatment
plan, which makes the law difficult to enforce. Some experts called
it “toothless.”
In a May letter, nearly 80 county residents and experts from across
the country urged County Executive Sara Innamorato and County
Council members to “challenge” the Department of Human Services’
intention to implement AOT and demanded “robust transparency and
accountability, including third-party evaluation … and engagement
with those directly impacted” if implementation moved forward.
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This story was originally published by Pittsburgh's Public Source
and distributed through a partnership with The Associated Press.
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