Maryland Launches Court-Ordered Mental Health Care in Baltimore

Maryland has begun allowing circuit court judges to order outpatient mental health treatment for certain patients, with the new Assisted Outpatient Treatment program launching this week in Baltimore City, Anne Arundel County, and counties on the Eastern Shore. The Maryland Department of Health announced the launch on August 20, putting into motion a mandate that state lawmakers approved two years ago but that took until now to reach patients on the ground.

The program lets mental health professionals, family members, or friends petition a circuit court to require a person with severe mental illness to follow a treatment plan, according to the Baltimore Sun. A person with a relationship to the patient, or a medical professional, can petition for an AOT plan using an online form, and in some cases a respondent can also voluntarily enter the plan themselves. The Maryland General Assembly passed the underlying legislation, known as HB 576 and SB 453, in 2024, and that law set a July 1, 2026 deadline for every Maryland jurisdiction to either run its own program or fall back on the state to do it, according to the Maryland Department of Health.

Every one of Maryland's 24 jurisdictions ultimately deferred to the state health department to build and run the program rather than developing their own local version, per the Baltimore Sun's reporting. The rollout starting this week covers only Baltimore City, Anne Arundel County and the Eastern Shore for now, with the program set to expand statewide by July 2027.

Why State Officials Say Voluntary Care Often Fails

Maryland Health Secretary Meena Seshamani said maintaining treatment engagement and consistency can be a daily challenge for many people living with severe mental illness, and that the new program creates a structured pathway to community-based treatment, stability and recovery, according to the Baltimore Sun. Left unaddressed, behavioral health challenges can lead to repeated hospitalization or incarceration, the outlet reported.

Testimony submitted to the Maryland General Assembly during the 2024 legislative session laid out the clinical rationale advocates used to justify the intervention: roughly 40% of people diagnosed with bipolar disorder and about 50% of those with schizophrenia experience anosognosia, a neurological condition that keeps patients from recognizing they need medical care, according to testimony filed with the Maryland General Assembly. Both bipolar disorder and schizophrenia can interfere with a patient's ability to recognize the need for care, the testimony noted. Before this year, Maryland was one of only three states without an Assisted Outpatient Treatment law; with its adoption, 48 states now have AOT statutes on the books, according to the Treatment Advocacy Center.

Once enrolled, participants are supported by a multidisciplinary Care Coordination Team that includes a psychiatrist, a case manager, a Certified Peer Recovery Specialist and a program director, according to the Maryland Daily Record. The state health department has also scheduled a multimedia public awareness campaign starting in September to train law enforcement, mental health facilities and care coordinators on referral procedures ahead of the program's wider expansion.

Counties Balk at Future Reimbursement Bills

Not everyone involved in rolling out the program is comfortable with how it will be paid for. Karrington Anderson said local officials were surprised by new reimbursement language in the state budget and that counties still have unanswered questions about the program's costs, per the Baltimore Sun's account. Under that budget language, Maryland counties will be required to reimburse 25% of state funds spent on AOT services in their jurisdictions starting in 2028, with that share rising to 100% by 2031.

Anderson said officials will work to make the program successful while weighing the ethical and implementation issues it raises, the Baltimore Sun reported. Local officials are still working out implementation logistics with state officials, and the program currently has few public details about what happens if a patient does not cooperate with a court-ordered treatment plan.

Disability Rights Advocates Push Back

Disability rights advocates have labeled the program involuntary outpatient commitment and argue it infringes on patients' rights to make their own medical decisions, according to the Baltimore Sun. In formal testimony opposing the 2024 legislation, Disability Rights Maryland argued that involuntary outpatient commitment strips people of bodily autonomy and fails to meet the state's obligations under the Americans with Disabilities Act to provide care in the least restrictive setting, according to testimony the organization filed with lawmakers. Advocates also testified in 2024 that they worried the law could lead to traumatizing interactions between patients and state agents.

Those concerns echo a broader national debate over whether court-ordered outpatient treatment actually works. A July 2025 report from the U.S. Government Accountability Office found that federal evaluations of Assisted Outpatient Treatment programs nationwide have produced inconclusive results, with randomized studies offering contradictory evidence on long-term treatment outcomes, according to the Government Accountability Office. Baltimore City had already tested a smaller-scale version of this approach before the statewide law passed, running a localized Outpatient Civil Commitment pilot through Behavioral Health System Baltimore to connect high-need psychiatric patients with community care.

Lawmakers are also weighing how the program intersects with gun ownership. During the 2026 legislative session, companion bills HB 1306 and SB 942 were introduced to require people subject to an AOT court order to surrender their firearms and refrain from purchasing new ones for the duration of the order, according to the Maryland Psychiatric Society. Whether that measure becomes law remains an open question as the state's broader rollout continues.

Court-ordered treatment has already surfaced in other recent Baltimore cases, including a probation deal that followed a Baltimore veteran's police shooting and ongoing competency reviews tied to a Baltimore murder case. Those episodes underscore the same tension now playing out statewide: how Maryland's courts, health system and county governments will actually share responsibility for patients whose treatment is no longer entirely voluntary.