Program for severe mental illness finds success through involvement of a judge

San Antonio program graduate said Assisted Outpatient Treatment (AOT) saved his life

SAN ANTONIO – Eric Smith began his life as a talented and gifted student, but severe bipolar disorder took over in his teenage years.

Fast forward through a bout of addiction, which was co-occurring with severe mental illness, and he was eventually living out of his car and dealing with episodes of psychosis.

“I was arrested for a low-level offense. I was in jail for a month without any treatment for my diagnosis,” Smith said.

That’s when Bexar County probate Judge Oscar Kazen stepped in.

“He gets me transferred here to the San Antonio State Hospital where I’m stabilized, and then immediately after stabilization, I was stepped down into Assisted Outpatient Treatment,” Smith explained.

Assisted Outpatient Treatment (AOT) is a court-ordered program for people like Smith with severe mental illness who are caught in a cycle of hospitalizations, homelessness, and incarcerations.

“People like me who couldn’t perceive reality, couldn’t perceive our own illness, couldn’t understand our need for treatment, couldn’t understand the danger that I was putting myself in,” Smith said, referring to those who receive help from the program.

Smith said the program’s success lies in the “black robe effect.”

“It uses the added accountability layer of a judge to make sure that the team itself -- that’s the psychiatrist, social worker, nurse and so on -- that they’re held accountable to each other,” Smith said. “Something about the involvement of a judge never threatening punishment against me but holding a team accountable -- it resonated with me. This is an individual in a position of power who has my well-being and interests at heart.”

It’s a civil order, not a criminal order, and it lasts, on average, six to 12 months.

“Part of the beauty of it, it’s not this cookie cutter approach -- where it’s like, ‘He’s doing well, but it has to be 12 months. They’re like, ‘Well, no, he’s doing very well, and it’s apparent he can go live his life,” Smith said.

However, he explained there are also no punishments if you don’t complete the program.

“Once that order is terminated, there are individuals in the community that that person is connected with to make sure that our treatment continues, that we make sure that we are set up for the best possible path for success, for health, for happiness,” Smith said.

Smith said AOT saved his life but said he sees the positive effects from a societal standpoint.

“The amount of money that’s spent on police having to show up and be part of that scene or transport an individual, as they did with me when I was arrested. Being involved in the criminal justice system, paying the judge all of that, the amount of time and energy that’s spent by them, spent by society, spent by a hospital,” Smith explained.

He wants people to know not everyone with severe mental illness needs something like this.

“Some people, they didn’t find themselves going to the FBI headquarters like I did. I was like, ‘I broke codes. I can help prevent World War Three. I was awake for days at a time, all kinds of stuff that are just dangerous for a person,” Smith said.

Now he’s healthy, on the correct medications, and living a full life.

As an AOT advocate, Smith now travels to share his story. He’s become a public speaker and consultant who has been featured by Oprah Daily, National Public Radio, Dr. Drew’s podcast and live streaming show, New York Daily News, and Yahoo! News.

He also speaks at events like the National AOT Symposium, which was held last month in San Antonio.

Bexar County has a strong AOT program, so it was chosen to host the latest national conference on the topic.

“We got to hear from judges around the U.S., stakeholders around the U.S., family members who are just begging to find out, ‘How can we get an AOT program in our area around the U.S. like we have here in San Antonio?’” Smith said.

Although 47 states have adopted AOT programs, some oppose it, claiming it’s forced treatment.

“I can clearly state that I was never forced to do anything I didn’t want to do. My feedback was valued. When I said, ‘I don’t like the side effects of these meds,’ it was changed,” Smith said.

A lot of what he educates people about is a condition he experienced called anosognosia, a symptom of severe mental illness experienced by some that can impair a person’s ability to understand and perceive his or her illness.

Experts report anosognosia as the single largest reason people with schizophrenia or bipolar disorder refuse medications or do not seek treatment.

“It is not some severe form of denial where someone is just unwilling to accept reality. There are actual changes in the brain, not dissimilar from someone who would be experiencing Alzheimer’s or dementia,” Smith said.

He offered an anecdote as an example:

“Imagine someone driving down a highway at 90 miles an hour. They know to some degree or another that they might get it stopped and ticketed. They might get into a wreck. They’ve made, even the most basic of levels, a risk-benefit analysis of what they’re doing,” Smith explained. “Now, picture me driving down the highway 90 miles an hour in the midst of a bout of psychosis, and I’m thinking, ‘I got to speed, I got to get where I need to go. Spies are chasing me.’ I’m very paranoid and delusional about it all. ‘If I get stopped by police, they’ll let me go because I’m working in cahoots with the FBI and the CIA.’”

Though it’s vulnerable to bear it all, Smith will continue sharing his story to educate the public and help people just like him.

At the request of lawmakers and other stakeholders, he has provided testimony in Texas, Virginia, California, Washington, Massachusetts, and Maryland in favor of AOT.

Smith has also returned to school to get his masters in social work and is already working with people experiencing homelessness at SAMMinistries.

About the Authors:

Courtney Friedman is a KSAT anchor and reporter. She has an ongoing series called Loving in Fear, confronting Bexar County’s domestic violence epidemic. She's also covered Hurricane Harvey, the shootings in Sutherland Springs and Santa Fe, and tornadoes throughout Texas. She’s a California native and proud Longhorn who loves calling SA home.

Before starting at KSAT in August 2011, Ken was a news photographer at KENS. Before that he was a news photographer at KVDA TV in San Antonio. Ken graduated from San Antonio College with an associate's degree in Radio, TV and Film. Ken has won a Sun Coast Emmy and four Lone Star Emmys. Ken has been in the TV industry since 1994.