The Maryland Department of Health this week announced the launch of the state’s new Assisted Outpatient Treatment program, a court-ordered mental health treatment system that’s been more than two decades in the making — and one that drew significant opposition from civil-liberties and disability-rights advocates before it passed.
The program, now operating in Anne Arundel County, Baltimore City, and the Eastern Shore, provides structured, community-based treatment to people with severe mental illness who’ve struggled to stick with voluntary care. A public awareness campaign aimed at law enforcement, mental health facilities and case managers begins in September, ahead of a planned full statewide rollout in July 2027.
“The Assisted Outpatient Treatment program is designed to bridge the gap between an individual’s struggle and effective, consistent care by creating a structured pathway to community-based treatment, stability and recovery,” Maryland Health Secretary Dr. Meena Seshamani said in the announcement.
Maryland was one of only three states without any form of assisted outpatient treatment before this law passed. Similar legislation had been proposed repeatedly over the prior 23 years, often pushed by the national Treatment Advocacy Center, and was defeated every time until 2024, when Senate Bill 453 passed with bipartisan support and backing from Gov. Wes Moore.
As originally written, the law required every Maryland county to either stand up its own AOT program or default to state administration by July 1, 2026. In practice, every single one of Maryland’s jurisdictions opted to defer to the state rather than run a local program, according to the Maryland Association of Counties, citing unresolved regulatory questions, funding gaps and implementation concerns — which is part of why the rollout is beginning now, phased by region, rather than all at once statewide.
Under the program, participants work with a multidisciplinary Care Coordination Team — a psychiatrist, case manager, Certified Peer Recovery Specialist and program director — who help build an individualized treatment plan. Services can include medication management, housing and transportation assistance, crisis coordination and referrals to behavioral health or substance use treatment. Participants are placed into the program through a court petition and hearing process, and the law specifically requires Maryland’s Office of the Public Defender to represent individuals in those proceedings — a due-process safeguard written into the statute. The Behavioral Health Administration is required to submit an annual report on program outcomes each December, and the law includes a sunset clause, expiring in June 2030 unless renewed.
The bill did not pass without pushback. During 2024 legislative hearings, opponents including licensed mental health clinicians and advocacy groups like Social Work Advocates for Social Change testified against the measure, raising concerns about forced treatment and warning it could disproportionately affect Black Marylanders. One group’s testimony cited data from the Maryland Office of the Public Defender showing that while Black residents make up about 12% of the state’s population, they accounted for 51% of special emergency petitions for court-ordered involuntary hospitalization — a disparity opponents argued AOT could deepen rather than address. Supporters countered that the program targets a genuine gap for people who cycle repeatedly through crisis care without sustained treatment, and note that Maryland was following a model already adopted, in some form, by every other state but two.
New York’s similar program, known as Kendra’s Law, has also faced scrutiny elsewhere — a 2024 New York Times investigation found what reporters described as fatal lapses in that state’s implementation, according to reporting cited in a Psychiatric Times analysis of Maryland’s new law. It’s not yet clear how closely Maryland’s version will track New York’s model in practice, since the program is only now getting underway.
Deputy Secretary for Behavioral Health Dr. Rachel Talley said the department’s initial focus is on training professionals to identify and refer appropriate candidates. “Through a collaborative, person-centered approach, we hope to empower participants to remain consistently engaged in their treatment, fostering long-term recovery and sustained stability,” Talley said.
More information, including for professionals and families, is available at health.maryland.gov/TryAOT.
This story touches on mental health treatment and involuntary care. If you or someone you know is experiencing a mental health crisis, the 988 Suicide & Crisis Lifeline is available by call or text at 988, and the Maryland Crisis Hotline can be reached at 211 (press 1).
