On 3 July 2014, Misty Mayo boarded a Greyhound bus bound for Los Angeles. Desperate to escape her hometown of Modesto in Stanislaus County, 300 miles north in California’s Central Valley, the 41-year-old thought the 4th of July fireworks in LA would be the perfect antidote.
Even a mugging at the Modesto bus station didn’t deter her. When she arrived in LA the next morning with just a few dollars in her pocket, Misty immediately asked a police officer for directions to the fireworks display. She also knew she would need to find a Target pharmacy to refill her medication, but decided it could wait until later.
Later came and went. With no money in a strange city, Misty found the bus system too confusing to navigate. The longer she went without her cocktail of antipsychotics to keep the worst symptoms of her schizoaffective disorder at bay, the more difficult it became to remember that she even needed medication. In the sweltering July heat, Misty roamed the streets of Santa Monica, trying to grab a few minutes of shut-eye where she could. Mostly, she was too afraid to sleep.
Misty’s worsening mental state left her combative and paranoid. Her memories of this time are vague at best, but hospital records show a series of psychiatric hospitalisations during July and August. She was arrested at least once. By now, Misty no longer recognised that she had a health problem. Not surprisingly, she didn’t take her medications once out of hospital, and the cycle repeated itself over and over.
Back in Modesto, Misty’s mother, Linda, felt her worry turn to panic as the days passed without word from her daughter. She filed a missing persons report, and the next time police picked up Misty for her latest infraction, Linda got a phone call. Knowing where her daughter was, however, didn’t mean that she could help Misty, and she watched her daughter’s deterioration with horror and fear.
“There really isn’t anything we can do. The only time she’s going to get help is if they put her in the hospital, and the only way they’ll put her in the hospital is if she’s a danger to self or others,” Linda says. Wandering the streets and shouting at strangers, without adequate food and water, didn’t qualify.
Reference:
- Nevada County provides background information and reports on their experience with AOT, including outcomes for patients.
- Marvin Swartz’s North Carolina study, published in 2001, concluded that outpatient commitment worked if the court order was sustained and involved relatively intense treatment.
- A 2009 evaluation of AOT in New York suggested it brought benefits to patients.
- In a position statement published in 2015, Mental Health America explained its opposition to outpatient commitment as well as offering principles to guide its use where such legislation is in place.
- Tom Burns’s research, published in 2016, suggested community treatment orders were not beneficial to patients in the UK.
- The Treatment Advocacy Center has set out arguments in favour of AOT, including links to several relevant research studies.
- The National Alliance on Mental Illness explains what anosognosia means.
- Find out more about schizophrenia and schizoaffective disorder from Mind, a UK mental health charity.
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