Kendra's Law works and should be renewed
By Mary Barber
Albany Times Union
Five years ago, Kendra's Law brought assisted outpatient to New York state. The program mandates outpatient psychiatric treatment through a court order for a small population with severe mental illnesses, mostly schizophrenia, who are too ill to make informed treatment decisions.
As the law expires this year, we at Ulster County Mental Health Department urge continuation of assisted outpatient treatment with state funding to ensure the long-term viability of the law.
We were initially skeptical about the program. It was an unfunded mandate that added only a couple of new intensive case management slots. We believed the law had no teeth and that court petitions would not change the behavior of a patient truly resistant to treatment. We guessed that case management resources might help some patients, but that court orders would add little beyond that.
We feel much differently after five years of experience with the law.
Kendra's Law makes counties responsible for their most high-risk, high-need people. With that responsibility comes the opportunity to exert more centralized control over housing, treatment and case management resources, which benefits the system as a whole.
Much of the effectiveness of assisted outpatient treatment comes from making providers accountable. The law allows and requires close communication among all providers. This helps avoid fragmentation of care and patients slipping through cracks in the system.
Assisted outpatient treatment also supports providers in helping those hardest to help. Providers are more willing to take in severely ill and high-risk patients when they know the assisted outpatient treatment team will help oversee these cases, including developing new strategies if patients become symptomatic or a particular housing or treatment arrangement doesn't work.
Many patients feel compelled to follow court orders, even knowing that the most severe consequence if they do not follow their treatment plan is being taken to an emergency room (something most of the patients who are placed on petitions have already experienced numerous times). We have witnessed many amazing successes for people on petitions.
The petitions, with their specific treatment plans, provide a much-needed consistency for patients. In the past, these patients have often been shuffled among different clinics, hospitals and jails. They have been given multiple short trials of different medications, with little communication between different parties involved in their care. The treatment plan written in a patient's court petition follows that patient for the duration of the petition and is adhered to by all involved providers. This consistency is crucial.
Intensive case management and oversight by the assisted outpatient treatment coordinator and psychiatrist benefit patients on enhanced services -- voluntary services that some patients accept in lieu of court orders. For some patients, however, adding services is not enough, and a court order is necessary.
We have conducted 90 assisted outpatient treatment investigations. Of these, 47 people received enhanced services and 15 have gone on to require a court petition. For this significant minority, court is an important addition. The most common reason for our county to not renew a petition at its expiration has been improvement by the patient to the point that he or she could participate voluntarily in treatment, which speaks to the positive effect these petitions have. For many, this is the first period of stability they have experienced in years.
Over a three-year period, among people on assisted outpatient treatment in Ulster County, hospital and jail stays are estimated to have been reduced by 3,500 days and 1,000 days, respectively. Clearly, assisted outpatient treatment petitions have saved patients from more restrictive institutional settings, saved our community money and kept our community safer by avoiding the incidents that lead to jail and hospital stays.
The centralized management of Ulster County's assisted outpatient treatment program by a coordinator and psychiatrist is key to its success, but this centralization is not cheap. Our local government fully funds the coordinator and psychiatrist positions, and our attorney hours. We have been fortunate as a county to have a legislature willing to support this level of service. In other counties, where these resources are lacking, enforcement of the law may not be as active.
We urge the state Legislature to renew Kendra's Law and to provide more funding to support it. This will ensure that programs will survive through difficult local budget cycles. It will also ensure more consistency across counties, rather than being dependent on the good graces of each local government.
Our initial doubts have been soundly invalidated by assisted outpatient treatment successes. Now that we know it works, let's support it fully.
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