KENDRA’S LAW New York’s Law for Assisted Outpatient Treatment (AOT)
A Brief Overview of the law and the results
Synopsis
Kendra’s Law was initially proposed in 1999, by families of individuals with the most serious mental illnesses as a way to help their loved ones while simultaneously keeping society safer. Kendra’s Law does two things:
- It allows courts -after extensive due process- to order a certain group of narrowly defined individuals with serious mental illness who already have a past history of multiple arrests, incarcerations or needless hospitalizations to accept treatment as a condition for living in the community. Before Kendra’s Law, the law required people so ill they refuse treatment to become dangerous before they can be required to accept treatment. Families felt the law should prevent dangerous behavior, rather than require it.
- Kendra’s Law allows judges to order the recalcitrant mental health system to serve people with serious mental illness, rather than cherry picking the easiest to treat for admission.
Results
Since its enactment, Kendra’s Law has been the subject of multiple studies. These studies have consistently found that the program helps the mentally ill and that those in it say it helps them get well and stay well. Studies found it
- reduced homelessness (74%);
- reduced suicide attempts (55%);
- reduced substance abuse (48%);
- reduced physical harm to others (47%);
- reduced property destruction (43%);
- reduced hospitalization (77%);
- reduced arrests (83%);
- reduced incarceration (87%).
A study released in 2009 found that Kendra’s Law causes no increase in perceived stigma or coercion among recipients, and that the court orders themselves (not just the availability of high-quality services) are instrumental in the program’s success. A 2010 Columbia University study found that individuals under Kendra’s Law orders, despite greater histories of violence, were four times less likely to engage in future violence than those in a control group. Independent studies have shown that Kendra’s Law is non-discriminatory and applied equally throughout the state.
Studies also found it improved the mental health system by improving communication, collaboration, access to services, accountability, and helping it to prioritize the most seriously ill, thereby saving money that could be put to other uses.
Support
Kendra’s Law was originally passed and subsequently renewed by the NYS Legislature with extensive bipartisan support. Supporters include the National Alliance for Mental Illness of NYS; American Psychiatric Nurses Association; NYS Sheriff’s Association; NYS Chiefs of Police Association; Greater NY Hospital Association; Public Employees Federation; District Attorney’s Association of the State of NY and others. The law was originally endorsed by the New York Times, Newsday, Daily News, New York Post, Albany Times Union, Buffalo News and others
Kendra’s Law is an important advance.
1. It allows individuals to be ordered into treatment without ordering them into a hospital. It is a less-restrictive, less-expensive, more humane form of ‘commitment’ than inpatient commitment. It enables people with mental illness to maintain more of their civil liberties.
2. the criteria to place someone in assisted outpatient treatment are easier to meet than the “imminent dangerousness” standard often required for inpatient commitment in New York. Kendra’s Law allows someone to be ordered into treatment “to prevent a relapse which or deterioration which would likely result in serious harm to the patient or others. (provided they have a past history of violence, incarceration or needless hospitalization) In other words, there is no need to wait until a deteriorating consumer actually is dangerous to self or others, as in the inpatient standard; under Kendra’s Law you can start procedures to “prevent a relapse” that could lead to dangerousness.
3. The law not only allows courts to commit individuals to receive care, the courts can also commit the mental health system to providing it. Historically, highly symptomatic individuals have been turned away or neglected by programs that prefer less symptomatic easier to treat individuals.
The law includes strict eligibility criteria and numerous consumer protections. Courts have determined that the narrowly defined eligibility criteria and numerous due process protections, ensure Kendra’s Law is constitutional, does not violate civil rights, and is an appropriate use of the states’ parens patriae power (to help those who can’t help themselves) and police powers (to keep the public safe).
Improvements Needed
In light of the success of the law, it should be amended to see that more who could benefit from it, receive it. Current procedure is to discharge involuntarily committed patients and prisoners who have received mental health services while incarcerated or hospitalized to the community without requiring them to stay in treatment. If someone is discharged from a hospital after being involuntarily committed (i.e, they were danger to self or others), the state should evaluate that person to see if they could benefit from AOT. Likewise, someone discharged from jail or prison who received mental health services while incarcerated, should be evaluated to see if they could benefit from AOT. This would keep patients healthier and the public and patient’s safer.
Opposition
NYS Commissioner of Mental Health Michael Hogan claims to support the law, but behind the scenes remains one of the biggest impediments to seeing those who could benefit from the program get access. Assemblyman Felix Ortiz has investigated the evidence, knows it works, promised and refused to hold hearings and more importantly, refused to let bills that close loopholes come to a vote.
Some individuals who object to Kendra’s Law argue that if the state had more community-based treatment resources, the law would not be necessary. While there is no doubt that investments in community-based treatment are sorely needed, Kendra’s Law is only for a subgroup of the most symptomatic who refuse voluntary services. More services they can refuse does not help these individuals as lack of insight into one’s own illness (anosognosia) prevents them from recognizing the need. Some trade associations purporting to represent people with mental illness correctly argue that most people with mental illness are not violent. But Kendra’s Law is not targeted at “most people with mental illness”, it is only a narrowly defined subgroup. Unfortunately these groups have created their own pseudo-studies in support of claims they want the public to believe. The legislature has funded independent studies that show most of their claims (including bias) are unfounded.
Statement of need
In enacting Kendra’s Law, the legislature found that some people, as a result of mental illness, have great difficulty taking responsibility for their own care, and often reject outpatient treatment offered to them on a voluntary basis. These individuals often commit suicide; become homeless; end up in jail; or, on rare occasions, are involved in acts of violence. Family members and caregivers often must stand by helplessly and watch their loved ones and patients decompensate to actual “dangerousness”.