Improvements in Kendra’s Law included in NYS Assembly Bill A6987 introduced 4/11/11 by Assembly member Alleen Guther and Senate Bill 4881 introduced by Senator Catherine Young
Background: Kendra’s Law (9.60) (Assisted Outpatient Treatment-AOT) allows courts to order certain violent and/or recidivist mentally ill individuals to accept treatment as a condition for living in the community. It also commits the mental health system to providing the treatment. Since its original passage in 1999 it has been the subject of several studies. These studies found Kendra’s Law:
Helps the mentally ill by reducing homelessness (74%); suicide attempts (55%); and substance abuse (48%); Keeps the public safer by reducing physical harm to others (47%) and property destruction (43%). Saves money by reducing hospitalization (77%); arrests (83%); and incarceration (87%).
A 2010 study found “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.” They found less frequent psychiatric hospitalizations, shorter length of hospitalizations, reduction in the likelihood of arrest, higher social functioning, greater service participation and slightly less stigma, and complete racial neutrality.
In addition to these positive findings, these studies and others suggested areas for streamlining, improving, and lowering the cost of the program. These changes are supported by NAMI-NYS; Harlem Alliance on Mental Illness as well as the leading public safety organizations such as NYS Sheriffs Association, NYS Chiefs of Police, etc.
On 4/11/11 Assemblymember Aileen Gunther introduced A-06987 incorporating thise changes.
Loopholes and problems in Kendra’s Law that would be remedied by A-06987
A crack in the system allows mentally ill prisoners to be discharged into the community without screening to determine if they need court ordered treatment to stay healthy and prevent them from becoming violent. When a correction facility discharges a mentally ill prisoner they would be required inform the director of community services and OMH, and suggest whether or not they believe the inmate meets the criteria for AOT. The Director of Community Services and OMH are free to investigate, provide additional services, petition for Assisted Outpatient Treatment or do nothing. A crack in the system allows people who were involuntarily committed to inpatient treatment because they were ‘danger to self or others’ to be released without first determining whether they need mandatory treatment to help them stay healthy and prevent them from becoming violent. If a hospital is discharging someone who has been involuntarily committed (ie, already ‘danger to self or others), the hospital would report that discharge to the local county mental health commissioner along with a statement as to whether or not they believe the person meets the criteria for AOT.The Director of Community Services and OMH are free to investigate, provide additional services, petition for Assisted Outpatient Treatment or do nothing. A crack in the system allows a court order to stay in treatment to become unenforceable if the person moves to a different county. If someone in assisted outpatient treatment moves to a different county, the move would be reported through existing channels to the new county of residence.The Director of Community Services in the county of residence are free to investigate, provide additional services, petition for Assisted Outpatient Treatment or do nothing. A crack in the system allows court orders to expire without a review of whether they should be renewed or not. This is because many petitions are initiated by hospitals. Once the patient is out of hospital, the hospital has no obligations to patient. As a result, petitions expire without a review. Requires AOT coordinators to proactively review expiring court orders to determine if they should be renewed, more services provided, or nothing. Make it easier for families of mentally ill to keep their mentally ill sons, daughters and spouses at home. Clarify that a county should investigate reports of individuals in need of AOT that are received from family and community members in addition to hospital directors.* Some small counties can’t use Kendra’s Law because they don’t have a qualified psychiatrist to examine the patient and develop a treatment plan. Require OMH to provide a doctor as needed to facilitate the AOT process in counties with under 75,000 residents. Psychiatrists are making decisions with needlessly incomplete information Require physicians to make a reasonable effort to gather useful information from a member of the patients family or significant other.* Court orders are forced to expire, before they have maximum impact. Research requested by legislature shows when someone is under AOT for one-year (vs. six months) the increase in medication compliance, and reductions in violence continue even after the treatment order ends. Bill increases the maximum amount of time someone could be put under court ordered treatment from 6 months to one year. (Note: There is no minimum, and orders can be reviewed any time). It takes too long to determine if a patient who materially violates a court order needs inpatient care to prevent deterioration. Allow doctors to (under certain conditions) presume that patients who materially violate their treatment orders should be taken to a hospital for an evalation (only) to see if they need admission. Needless and expensive court hearings have to be held even if the patient (and his/her lawyers) agree to the psychiatrists findings. Allow patients after consulting with their court-appointed lawyer to stipulate to a psychiatrists finding. Many counties cut the cost of AOT by allowing patients to stipulate to a psychiatrists findings, This provision would make it clear that that is allowed and extend the optional practice statewide to save money.
Prepared by Mental Illness Policy Org. https://mentalillnesspolicy.org
* Changes suggested to NYS Legislature by research legisature asked to be conducted.