case manager agreed on what was important to work on. in nevada county, ca, aot ("laura's law") decreased the number of psychiatric hospital days 46.7%, the number of incarceration days 65.1%, the number of homeless days 61.9%, and the number of emergency interventions 44.1%. laura's law implementation saved $1.81–$2.52 for every dollar spent, and receiving services under laura's law caused a "reduction in actual hospital costs of $213,300" and a "reduction in actual incarceration costs of $75,600." in new jersey, kim veith, director of clinical services at ocean mental health services, noted the aot pilot program performed "beyond wildest dreams." aot reduced hospitalizations, shortened inpatient stays, reduced crime and incarceration, stabilized housing, and reduced homelessness. of clients who were homeless, 20% are now in supportive housing, 40% are in boarding homes, and 20% are living successfully with family members. writing in the british journal of psychiatry in 2013, jorun rugkåsa and john dawson stated, "the current evidence from rcts suggests that ctos do not reduce readmission rates over 12 months." "we find that new york state's aot program improves a range of important outcomes for its recipients, apparently without feared negative consequences to recipients." "the increased services available under aot clearly improve recipient outcomes, however, the aot court order, itself, and its monitoring do appear to offer additional benefits in improving outcomes." access to services "aot has been instrumental in increasing accountability at all system levels regarding delivery of services to high need individuals. community awareness of aot has resulted in increased outreach to individuals who had previously presented engagement challenges to mental health service providers." "improved treatment plan development, discharge planning, and coordination of service planning. processes and structures developed for aot have resulted in improvements to treatment plans that more appropriately match the needs of individuals who have had difficulties using mental health services in the past." "improved collaboration between mental health and court systems. as aot processes have matured, professionals from the two systems have improved their working relationships, resulting in greater efficiencies, and ultimately, the conservation of judicial, clinical, and administrative resources. there is now an organized process to prioritize and monitor individuals with the greatest need; aot ensures greater access to services for individuals whom providers have previously been reluctant to serve; there is now increased collaboration between inpatient and community-based providers." in new york city net costs declined 50% in the first year after assisted outpatient treatment began and an additional 13% in the second year. in non-nyc counties, costs declined 62% in the first year and an additional 27% in the second year. this was in spite of the fact that psychotropic drug costs increased during the first year after initiation of assisted outpatient treatment, by 40% and 44% in the city and five-county samples, respectively. the increased community-based mental health costs were more than offset by the reduction in inpatient and incarceration costs. cost declines associated with assisted outpatient treatment were about twice as large as those seen for voluntary services. "in all three regions, for all three groups, the predicted probability of an mpr ≥80% improved over time (aot improved by 31–40 percentage points, followed by enhanced services, which improved by 15–22 points, and 'neither treatment,' improving 8–19 points). some regional differences in mpr trajectories were observed." "in tandem with new york's aot program, enhanced services increased among involuntary recipients, whereas no corresponding increase was initially seen for voluntary recipients. in the long run, however, overall service capacity was increased, and the focus on enhanced services for aot participants appears to have led to greater access to enhanced services for both voluntary and involuntary recipients." "it is also important to recognize that the aot order exerts a critical effect on service providers stimulating their efforts to prioritize care for aot recipients." race "we find no evidence that the aot program is disproportionately selecting african americans for court orders, nor is there evidence of a disproportionate effect on other minority populations. our interviews with key stakeholders across the state corroborate these findings." "we found no evidence of racial bias. defining the target population as public-system clients with multiple hospitalizations, the rate of application to white and black clients approaches parity." service engagement "after 12 months or more on aot, service engagement increased such that aot recipients were judged to be more engaged than voluntary patients. this suggests that after 12 months or more, when combined with intensive services, aot increases service engagement compared to voluntary treatment alone." consumers approve. despite being under a court order to participate in treatment, current aot recipients feel neither more positive nor more negative about their treatment experiences than comparable individuals who are not under aot." "when the court order was for seven months or more, improved medication possession rates and reduced hospitalization outcomes were sustained even when the former aot recipients were no longer receiving intensive case coordination services." in los angeles, ca, the aot pilot program reduced incarceration 78%, hospitalization 86%, hospitalization after discharge from the program 77%, and cut taxpayer costs 40%. in north carolina, aot reduced the percentage of persons refusing medications to 30%, compared to 66% of patients not under aot. in ohio, aot increased attendance at outpatient psychiatric appointments from 5.7 to 13.0 per year. it increased attendance at day treatment sessions from 23 to 60 per year. "during the first 12 months of outpatient commitment, patients experienced significant reductions in visits to the psychiatric emergency service, hospital admissions, and lengths of stay compared with the 12 months before commitment." in arizona, "71% ... voluntarily maintained treatment contacts six months after their orders expired" compared with "almost no patients" who were not court-ordered to outpatient treatment. in iowa, "it appears as though outpatient commitment promotes treatment compliance in about 80% of patients... after commitment is terminated, about ¾ of that group remain in treatment on a voluntary basis." arguments against and opponents human rights advocate considers it a violation of freedom of thought or opinion, or views the use of neuroleptic as degrading treatment that can also impede on their right to work due to sometimes handicapping side effects. other argue for a right of self-determination or self ownership, considering it a paternalistic approach that can be wrongly applied considering psychiatry criteria for diagnosis are very subjective backed by some studies questioning diagnosis (see rosenhan experiment), the unlimited duration with often lack or no foresight to an end from the patient is also criticised. some opponents dispute the effects of compulsory treatment as positive, questioning the methodology of studies that show effectiveness. some point to disparities in the way these laws are applied. opponents claim they are giving medication to the patient, but there are no brain chemical imbalances to correct in "mental illness". our ability to control ourselves and reason comes from the mind, and the brain is being reduced in size from the psychiatric medications. the slippery slope argument of "if government bodies are given power, they will use it in excess." was proven when 350–450 ctos were expected to be issued in 2008 and more than five times that number were issued in the first few months. every year there are increasing numbers of people subject to cto's. the psychiatric survivors movement opposes compulsory treatment on the basis that the ordered drugs often have serious or unpleasant side-effects such as tardive dyskinesia, neuroleptic malignant syndrome, akathisia, excessive weight gain leading to diabetes, addiction, sexual side effects, increased risk of suicide and qt prolongation. the new york civil liberties union has denounced what they see as racial and socioeconomic biases in the issuing of outpatient commitment orders. the main opponents to any kind of coercion, including the outpatient commitment and any other form of involuntary commitment, are giorgio antonucci and thomas szasz.