Views on assisted outpatient treatment: Fuller Torrey, M.D.

AOT is essential because of anosognosia, Fuller Torrey, M.D., founder of the Arlington, Va.-based Treatment Advocacy Center, told Behavioral Healthcare and central to the legislative work Rep. Tim Murphy (R-Penn.) is trying to accomplish. “The whole issue of involuntary treatment is one that’s difficult to resolve,” he said. “Either you believe that nobody should ever be treated involuntarily and there’s no such thing as anosognosia, that people really can make decision – or you come down on the other side and say there’s a subset of people who have anosognosia, who cannot understand that they are sick,” he said. (Anosognosia is a condition in which the individual doesn’t realize that he or she is mentally ill.)

Torrey used AOT on patients in the District of Columbia when he worked at St. Elizabeth’s hospital, on a “fairly regular basis,” he said. “It was almost always a male,” he said, adding that women are less likely to refuse medication. “Typically, it was someone who had been in the hospital 15 times, had no awareness of his illness, and who would throw his medicine in the garbage on the way out.”

Torrey says he would go to court and say he knew he had to discharge the patient, but also knew the patient wouldn’t take his medication. “I would tell the court,” he said, ‘I would like to discharge him on the condition that he has to come back every two or three weeks to get his injection, and if he doesn’t come back, I have the legal right to send police out to get him.’That patient would come back and say, ‘The only reason I’m here is because you’re making me come here.’ And I would say, ‘Roll up your sleeve -- and how are you?’ And it worked.”

Torrey’s sister is a good example, he said. She was hospitalized for 25 years, after which she would always take her medicine. “She would take it because she learned that she would be right back in the hospital if she didn’t,” he said. “She liked life in the community.”

Read the pros and cons of AOT in the two-part series starting with part one by clicking here.