I live in Massachusetts—one of only two states in the country without an Assisted Outpatient Treatment (AOT) law. While some states have made progress, ours continues to criminalize those with severe mental illnesses rather than prioritize early intervention and treatment.
Massachusetts law fails to recognize anosognosia, the neurological condition where individuals are unaware they are ill. As a result, countless people like my son cycle through incarceration, homelessness, and emergency rooms—some losing their lives—while families are left helpless.
I am a mental health advocate working tirelessly to improve outcomes for those with no-fault brain illnesses and their families. Yet despite everything I’ve done to help others, it was only a matter of time before my own son fell into the same broken system.
My son is college-educated, a former athlete, and one of the most compassionate people I’ve known. He was the grandchild who always showed up for his grandmother with Alzheimer’s and his grandfather with dementia. But since being diagnosed in college with bipolar I with psychotic features, he has been hospitalized seven times. He remains unmedicated because he does not believe he is ill. In his psychosis, he’s reimagined a childhood of abuse and accuses us—his devoted parents—of drug use. These are delusions, born from a brain illness. My husband coached his sports. I gave up my career to raise our children. Our family did not have trauma. But psychosis created trauma where none existed.
In Massachusetts, DMH caseworkers can drop clients simply because they say they no longer want treatment—even when they clearly lack insight into their condition. Services are not tied to medical need but to whether someone agrees to care—no matter how ill or impaired. That’s not care. That’s neglect.
Families like mine are grieving the living. We’ve lost children who are still physically here. The lives they could be leading are just out of reach—not because we failed to help them, but because our state refuses to offer meaningful, timely intervention.
Meanwhile, law enforcement is left to carry the burden. Officers are too often blamed when the system has failed long before a crisis. When tragedy strikes, society blames the family or criminalizes the individual. But mental illness does not discriminate. My son comes from a loving, well-resourced home—and still, we have no options, because he cannot recognize he is sick.
How many more families need to suffer? How many people must die, or end up behind bars, before Massachusetts stops looking the other way?
We will no longer suffer in silence. We will keep telling our stories. The cost of not caring—in lives lost, families destroyed, and criminal justice expenses—is astronomical. AOT is not about coercion. It is about providing structured, compassionate medical care to those who are too sick to seek it themselves. It is a lifeline.
My son has now had three encounters with the criminal justice system, yet he remains untreated. He has been unable to work for over two years. His illness has caused chaos within our family, fracturing relationships and leaving us in a state of constant crisis. It doesn’t have to be this way. With proper laws and early intervention—like Assisted Outpatient Treatment—this cycle could be broken. Recovery is possible, but only if Massachusetts decides to care before tragedy, not after.
We need to stop punishing people for having a brain illness and start helping them live the lives they deserve. We can do better—and we must.
Those with serious mental illness can lead meaningful, fulfilling lives. We must act. Lives depend on it.
Each story is shared by someone impacted by untreated SMI,
lightly edited for clarity, never for meaning.
Do you have an ask? If you were sitting down with your legislator, how would you ask them to help you?
Our legislators must support passing an AOT law in Massachusetts, one of the last two states in the entire country to have such a law.
