Research from the ten independent studies
conducted over ten years
on NYS Assisted Outpatient Treatment (Kendra's Law)
"Kendra's Law" is New York State's version of "Assisted Outpatient Treatment" (AOT). AOT allows courts to order certain historically and potentially violent people with mental illness to stay in treatment as a condition for living in the community. It not only 'commits' the individual to accept care, it 'commits' the mental health system to providing it. Following is a summary of research on the effectiveness of Assisted Outpatient Treatment.
|May 2011 Arrest Outcomes Associated With Outpatient Commitment in New York State Bruce G. Link, et al. Ph.D. Psychiatric Services
||For those who received AOT, the odds of any arrest were 2.66 times greater (p<.01) and the odds of arrest for a violent offense 8.61 times greater (p<.05) before AOT than they were in the period during and shortly after AOT. The group never receiving AOT had nearly double the odds (1.91, p<.05) of arrest compared with the AOT group in the period during and shortly after assignment."
|March 2005 N.Y. State Office of Mental Health “Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment. “
Danger and Violence Reduced
- 55% fewer recipients engaged in suicide attempts or physical harm to self
- 47% fewer physically harmed others
- 46% fewer damaged or destroyed property
- 43% fewer threatened physical harm to others.
- Overall, the average decrease in harmful behaviors was 44%.
Consumer Outcomes Improved
- 74% fewer participants experienced homelessness
- 77% fewer experienced psychiatric hospitalization
- On average, AOT recipients' length of hospitalization was reduced 56% from pre-AOT levels.
- 83% fewer experienced arrest
- 87% fewer experienced incarceration.
- 49% fewer abused alcohol
- 48% fewer abused drugs
Consumer participation and medication compliance improved
- The number of individuals exhibiting good adherence to medication increased by 51%.
- The number of individuals exhibiting good service engagement increased by 103%.
Consumer Perceptions Were Positive
- 75% reported that AOT helped them gain control over their lives
- 81% said AOT helped them get and stay well
- 90% said AOT made them more likely to keep appointments and take medication.
- 87% of participants interviewed said they were confident in their case manager's ability to help them
- 88% said they and their case manager agreed on what is important for them to work on.
Effect on mental illness system
· Improved 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.
o There is now an organized process to prioritize and monitor individuals with the greatest need;
o AOT ensures greater access to services for individuals whom providers have previously been reluctant to serve;
o Increased collaboration between inpatient and community-based mental health providers.
|July 2013: The Cost of Assisted Outpatient Treatment. Can it Save States Money? American Journal of Psychiatry
In the 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.
|October 2010: Assessing Outcomes for Consumers in New York's Assisted Outpatient Treatment Program Marvin S. Swartz, M.D., Psychiatric Services
||Consumers who received court orders for AOT appeared to experience a number of improved outcomes: reduced hospitalization and length of stay, increased receipt of psychotropic medication and intensive case management services, and greater engagement in outpatient services.
|February 2010 Columbia University. Phelan, Sinkewicz, Castille and Link. Effectiveness and Outcomes of Assisted Outpatient Treatment in New York State Psychiatric Services, Vol 61. No 2
- Kendra's Law has lowered risk of violent
behaviors, reduced thoughts about suicide and enhanced capacity to function despite problems with mental illness.
- Patients given mandatory outpatient treatment - who were more violent to begin with - were nevertheless four times less likely than members of the control group to perpetrate serious violence after undergoing treatment.
- Patients who underwent mandatory treatment reported higher social
functioning and slightly less stigma, rebutting claims that mandatory
outpatient care is a threat to self-esteem.
|October 2010: Changes in Guideline-Recommended Medication Possession After Implementing Kendra's Law in New York, Alisa B. Busch, M.D Psychiatric Services
||In all three regions, for all three groups, the predicted probability of an M(edication) P(ossesion) R(atio) ≥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.
|October 2010 Robbing Peter to Pay Paul: Did New York State's Outpatient Commitment Program Crowd Out Voluntary Service Recipients? Jeffrey Swanson, et al. Psychiatric Services
||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.
|June 2009 D Swartz, MS, Swanson, JW, Steadman, HJ, Robbins, PC and Monahan J. New York State Assisted Outpatient Treatment Program Evaluation. Duke University School of Medicine, Durham, NC, June, 2009
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.
- Court orders add value: 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.
- Improves likelihood that providers will serve seriously mentally ill: 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.
- Improves 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.
- Racial neutrality: 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.
|1999 NYC Dept. of Mental Health, Mental Retardation and Alcoholism Services. H. Telson, R. Glickstein, M. Trujillo, Report of the Bellevue Hospital Center Outpatient Commitment Pilot
- Outpatient commitment orders often assist patients in complying with outpatient treatment.
- Outpatient commitment orders are clinically helpful in addressing a number of manifestations of serious and persistent mental illness.
Approximately 20% of patients do, upon initial screening, express hesitation and opposition regarding the prospect of a court order. After discharge with a court order, the majority of patients express no reservations or complaints about the orders.
- Providers of both transitional and permanent housing generally report that outpatient commitment help clients abide by the rules of the residence. More importantly, they often indicate that the court order helps clients to take medication and accept psychiatric services.
- Housing providers state that they value the leverage provided by the order and the access to the hospital it offers.
|1998 Policy Research Associates, Inc. Research study of the New York City involuntary outpatient commitment pilot program.
- Individuals who received court ordered treatment in addition to enhanced community services spent 57 percent less time in psychiatric hospitals than individuals who received only enhanced services.
- Individuals who had both court ordered treatment and enhanced services spent only six weeks in the hospital, compared to 14 weeks for those who did not receive court orders.
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