Loopholes in Kendra’s Law that need closing.


Background: Kendra’s Law (9.60) (Assisted Outpatient Treatment-AOT) allows courts–after full due process–to order a small group of violent and/or recidivist mentally ill individuals who meet narrowly defined criteria to accept treatment as a condition for living in the community. It also allows courts to commit 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%).

These studies also found it helps the mental health system coordinate better and better focus their efforts on people who are most seriously mentally lll. Another study found that 81% of the consumers enrolled in Kendra’s Law said it helped them get and stay well. 90% said it made them more likely to keep appointments and take medication. And a third study found it is free of bias.**

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 the NYS Association of Chiefs of Police.

The mental health committees of NYS Senate and Assembly should:

        1. Close the crack in the system, whereby prisoners who relied on mental health services while imprisoned are discharged without alerting local mental health authorities so they can (if they choose) evaluate whether the released prisoner may need mandatory treatment to prevent them from becoming violent. *
        2. Close the crack in the system, whereby individuals who are involuntarily committed to inpatient treatment because they are ‘danger to self or others’ can be released without alerting local mental health authorities so they can (if they choose) evaluate whether the released patient may need mandatory treatment to prevent them from becoming violent.
        3. Close the loophole whereby if a person under court order moves to a different county, the new county is not informed of the fact.*
        4. Close the crack in the system whereby court orders can expire without a review of whether they should be renewed.*
        5. Clarify that a county should investigate reports of individuals in need of Kendra’s Law received from family members who may know the individual best.*
        6. Require physicians to make a reasonable effort to gather useful information from the consumer’s family or significant others so they can help make the right treatment decisions.*
        7. Allow commitments to Kendra’s Law to be for up to one year in order to Incorporate findings of research requested by legislature that shows treatment orders of one-year have a more sustained positive impact than shorter length orders.*
        8. Allow doctors to presume under certain conditions that patients who materially violate their treatment orders (ex. regularly refuse drug tests or regularly skip treatment) may be taken to a hospital to see if they need further care.
      1. Reduce court costs by allowing patients and their lawyers to stipulate to findings if they choose to do so.*

** Note, this research summary only covers independent research. For example, opponents of AOT had conducted their own “research’ that purports to have found bias in application. This alleged bias, was refuted by independent researchers hired by the legislature to investigate the claim.

* Changes suggested to NYS Legislature by research legislature asked to be conducted

Legislative language for facilitating these changes can be found in S4881/A6987 proposed by Senator Catherine Young and Assemblymember Aileen Gunther.

DJ Jaffe is Executive Director of the non-partisan Mental Illness Policy Org., and author of Insane Consequences: How the Mental Health Industry Fails the Mentally Ill. He is a critic of the mental health industry for ignoring the seriously ill, and has been advocating for better treatment for individuals with serious mental illness for over 30 years. He has written op-eds on the intersection of mental health and criminal justice policy for the New York Times, Wall St. Journal and the Washington Post. New York Magazine has credited him with being the driving force behind the passage of New York’s Kendra’s Law and Congress incorporated ideas proposed by DJ in the Helping Families in Mental Health Crisis Act.