Kendra’s Law could help mentally ill inmates

by E. Fuller Torrey and Mary Zdanowicz The Buffalo News OPINION EDITORIAL

Anyone concerned about infringing on people’s rights by requiring them to take medication should visit a jail. It is not a pretty sight.

The “trans-institutionalization” of citizens with mental illnesses from hospitals to jails is a national tragedy, not one restricted to New York’s counties. But New York is unique in that it has a mechanism to help stem the tide. Unfortunately, some New York counties are not making use of Kendra’s Law, a progressive law that can stop the revolving door of medication non-compliance that lands so many people with mental illness behind bars.

Kendra’s Law allows courts to order certain individuals with severe mental illnesses to comply with treatment while living in the community, a process called assisted outpatient treatment. Erie County uses Kendra’s Law, and it appears to be working. Six percent of people in Erie County jail have a severe mental illness, one-third less than Onondaga County jail (20 percent), one-fourth less than Niagara County jail (25 percent) and one-fifth less than Monroe County jail (30 percent).

This is not surprising. Court-ordered outpatient treatment, which is the basis of Kendra’s Law, has been shown to significantly reduce the risk of arrest for individuals with a history of prior arrests or violence and hospitalizations — and is used in Erie County at least three times more per capita than in these other counties.

Niagara and Onondaga counties have used court orders to guarantee treatment for only two people in the 30 months that Kendra’s Law has been in effect. Yet, each county has more than 100 people with mental illnesses in their jails on any given day.

Anyone concerned about infringing on people’s rights by requiring them to take medication should visit a jail. It is not a pretty sight. One Florida judge regularly takes people on a tour of the section of a local jail that houses inmates with mental illness. The images visitors see invariably drive home the message that reform is needed, including that state laws must be changed to incorporate assisted outpatient treatment like New York’s Kendra’s Law.

Advocates in several states are pushing for treatment laws like New York’s. Erie County’s reduced jail population is not the only indication that Kendra’s Law works when it is used. The statewide results from the first 141 people to receive assisted outpatient treatment showed:

A 129 percent increase in medication compliance.
A 26 percent decrease in harmful behavior.
A 100 percent decrease in homelessness.

Increasing medication compliance is the key. Michael Bennett, who died after repeatedly jumping headfirst into the bars of his cell, ended up in that cell because he stopped taking medication for paranoid schizophrenia. He fought with police as they tried to take him into custody, which may have contributed to their decision to take him to jail rather than a hospital.

Medication non-compliance is known to contribute to the kind of violent behavior Bennett exhibited. In one study of assisted outpatient treatment, individuals who didn’t take their medication were 63 percent more likely to be violent than individuals who complied with treatment regimens. The same study showed that court-ordered routine community services for at least six months reduced the risk of violence by half.

Court-ordered treatment for individuals who refuse medication and have a history of repeated institutionalization is not just common sense — it also makes fiscal sense.

But even Erie County could do better — it spends $200,000 each year to medicate inmates. What good does that do if there is no way to ensure that they continue taking medication when released from jail? It is far more humane and cost effective to use Kendra’s Law to ensure that people continue taking medication and stay out of jail — which costs an additional $30,000 annually per person on top of the cost of medication.

New York has what states like Florida want — a humane way to keep people with mental illness in treatment and out of jail. Onondaga, Niagara and Monroe counties will never stem the tide of mentally ill jail inmates unless they start using Kendra’s Law to treat citizens with mental illness in their homes rather than in jail.

E. FULLER TORREY, M.D., is president and MARY T. ZDANOWICZ is executive director of the Treatment Advocacy Center in Arlington, Va., http://, a national nonprofit organization working to eliminate barriers to treatment of severe mental illness.