Alliance Alert: The U.S. Government Accountability Office (GAO) has released a new report that reinforces a message the Alliance for Rights and Recovery and countless advocates have been making for years: There is no conclusive evidence that involuntary outpatient commitment—commonly known as Assisted Outpatient Treatment (AOT)—works better than voluntary services. The GAO’s independent analysis of HHS’s efforts to evaluate AOT confirms that the program’s outcomes are inconclusive.
This report is a wake-up call for policymakers: we must stop pouring resources into coercive, court-ordered treatment models that criminalize people simply for having unmet mental health needs. Instead, the focus must shift to expanding access to voluntary, person-centered, and culturally responsive services that actually engage people and support long-term recovery.
Key Takeaways from the GAO Report:
- No Proven Benefit Over Voluntary Support: HHS’s own evaluations, including comparisons between AOT and voluntary treatment participants, failed to show clear advantages of court-ordered treatment. The sample sizes were too small and inconsistent, and the results too weak to justify forced intervention.
- Flawed Evaluation Methods: The GAO found the assessments heavily relied on self-reported data—which are prone to inaccuracies—especially in sensitive areas like substance use. In many cases, participants were listed as enrolled voluntarily despite the program being designed as involuntary, further clouding the findings.
- State Variability Undermines Evidence: AOT implementation varies dramatically from state to state, making consistent evaluation nearly impossible.
What This Means:
This report reaffirms what we have always known: the supposed effectiveness of AOT lies not in the mandate itself, but in the access to services that comes with it. People improve when they are connected to quality support—not because they are forced into treatment by a court order.
The Alliance has long called for investment in voluntary outreach models, peer support, mobile crisis teams, housing, and trauma-informed services that people can trust and choose to engage with. These are the kinds of services that reduce hospitalizations, promote recovery, and preserve human dignity.
Our Call to Action:
We urge all policymakers, providers, and system leaders to take this report seriously and stop expanding forced treatment as a substitute for real solutions. The data are clear: coercion is not care.
We must:
- Expand voluntary mental health and substance use services
- Increase access to supportive housing, crisis response, and peer support
- Uphold the civil rights and autonomy of individuals with mental health conditions
- Stop using the court system as a gatekeeper for basic access to services
The path forward must be rooted in compassion, equity, and evidence—not coercion. The GAO has confirmed what so many in our community have experienced firsthand: forced treatment doesn’t work. Access, support, and choice do.
We remain committed to fighting for a recovery-oriented system that meets people where they are and builds lasting trust and healing.
HHS Assessments of Assisted Outpatient Treatment Have Yielded Inconclusive Results
By U.S. Government Accountability Office (GAO) | July 10, 2025
Fast Facts
Serious mental illnesses affected 14.6 million adults in 2023. Left untreated, such illnesses can lead to issues like poor health and higher medical costs.
Assisted outpatient treatment can help adults with serious mental illnesses who can’t live safely on their own. It can include medication and referrals for social services. But it is controversial because it’s court-ordered and involuntary.
HHS awards grants to organizations to provide this treatment. However, we found HHS had challenges assessing the effects of these grants. For example, most results were self-reported by people receiving treatment, and such data could have errors.
What GAO Found
Under assisted outpatient treatment, adults with serious mental illnesses can be ordered by a judge in a civil court proceeding to adhere to community-based treatment in accordance with applicable state laws. It is generally intended for individuals who have been assessed as unlikely to be able to live safely in the community without supervision. In 2014, federal law authorized the Department of Health and Human Services (HHS) to award grants to organizations to implement assisted outpatient treatment programs. The Substance Abuse and Mental Health Services Administration (SAMHSA), a component agency of HHS, has awarded about $146 million in assisted outpatient treatment grants to 63 grantees since the program’s inception in 2016. These 4-year grants were primarily awarded in three cycles: 2016, 2020, and 2024.
Two HHS agencies—the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and SAMHSA—have made efforts to assess the grant program. Topics studied included participant outcomes such as treatment adherence, psychiatric emergency room visits, hospitalizations, and arrests.
HHS Assessments of the Assisted Outpatient Treatment Grant Program
Based on its review, GAO determined that HHS’s assessments were inconclusive. Both efforts were hampered by methodological challenges, many of which were inherent in the program and beyond the two agencies’ control.
Examples of HHS Challenges Assessing the Assisted Outpatient Treatment Grant Program
ASPE’s outcome report also included an analysis comparing assisted outpatient treatment participants to individuals enrolled in voluntary treatment of similar intensity. However, data on both groups came from one of the six grantees, and factors such as small sample size limited ASPE’s ability to detect differences between the two groups.
Challenges assessing the grant program are likely to persist because, for example, state laws will continue to vary.
Why GAO Did This Study
Serious mental illnesses affected an estimated 14.6 million adults in 2023. Some of these individuals had not received any treatment in the previous year. Untreated mental illnesses can have negative effects, including worsening health, increased medical costs, and possible involvement with the criminal justice system.
Assisted outpatient treatment can help individuals with serious mental illnesses who do not recognize they are ill to receive needed treatment, according to its proponents. However, its involuntary nature makes its use controversial, and research on its effectiveness has produced mixed results.
The Consolidated Appropriations Act, 2023, includes a provision for GAO to report on assisted outpatient treatment programs that received grants from SAMHSA. This report describes HHS’s efforts to assess the effects of the grant program on participants’ health and social outcomes, and what the assessments have revealed.
GAO reviewed documentation and interviewed officials from HHS regarding its assessment efforts. GAO interviewed a nongeneralizable sample of six grantees, which GAO selected to obtain variation in, among other things, geographic location and levels of urbanization. GAO also interviewed representatives of six stakeholder organizations, including mental health professional associations and advocacy groups. The groups were selected to provide a range of views on assisted outpatient treatment.
For more information, contact Michelle B. Rosenberg at osenbergm@gao.gov.
Read the Full Report Here: GAO-25-107526, SERIOUS MENTAL ILLNESS: HHS Assessments of Assisted Outpatient Treatment Have Yielded Inconclusive Results