New York must make greater use Assisted Outpatient Treatment (ex. Kendra’s Law, Laura’s Law) to ensure individuals with mental illness receive treatment in the most integrated setting as required by Olmstead v. LC
Olmsted v. L.C., Held: Title II of the ADA requires services provided in the
“most integrated setting appropriate to the needs of the disabled, considering available resources.
“It is a common phenomenon that a patient functions well with medication, yet, because of the mental illness itself, lacks the discipline or capacity to follow the regime the medication requires.” . (Olmstead V. L. C. (98-536) 527 U.S. 581 (1999))
It must be remembered, for the person with severe mental illness who has no treatment the most dreaded of confinements can be the imprisonment inflicted by his own mind, which shuts reality out and subjects him to the torment of voices and images beyond our own powers to describe…. (Olmstead V. L. C. (98-536) 527 U.S. 581 (1999))
New Yorkers with serious mental illness are not living in most integrated setting
- 15,000 New Yorkers with mental illness are living in jails and prisons
- 4,000 New Yorkers with mental illness are living in state psychiatric hospitals
- In NY you are more likely to be incarcerated for mental illness than hospitalised
The problem is not lack of “available resources.” NY has “available resources”
- NYS spends in excess of $3 billion on mental healtth
- Individuals with serious mental illness are largely excluded from OMH programs especially if they lack the ability to volunteer. The seriously ill go to the end of the line while worried well go to front.
- OMH has never improved services for the most seriously ill, absent a court order.
- $665 million of OMH budget (1/3) wasted per Dr. Llloyd Sederer: “Thus, taken together, $665 of the $814 (more than 80 percent!) was spent, perhaps unnecessarily, on people with mental disorders, principally for the serious medical illnesses that they frequently suffer.”
- OMH refuses to focus existing resources on the most seriously ill. OMH serves 650,000. Only 3,600 are seriously mentally ill individuals in state hospitals and 1,871 are in assisted outpatient treatment programs. Maybe 100K are in other programs that help seriously mentally ill.
OMH policies transfer the seriously ill to shelters, prisons and jails in violation of Olmstead.
Research shows Kendra’s Law can help people live in the least restrictive most integrated settin. Once enrolled in Kendra’s Law
- 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.
- 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.
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.
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
For those who received AOT the odds of any arrest were 2.66 times greater and the odds of arrest for a violent offense 8.61 times greater before AOT than they were in the period during and shortly after AOT. The group never receiving AOT had nearly double the odds 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. “
(AOT) 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.
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
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.
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
Assisted Outpatient Treatment in numerous other states support the proposition that AOT enables individuals with serious mental illness to live in the least restrictive most integrated setting.
To be compliant with Olmstead, NY must make greater use of Kendra’s Law. To offer humane care for the most seriously ill NY should make use of Kendra’s Law.