Issue: Research shows there are three giant cracks in the NYS system involving the most seriously mentally ill and these cracks are putting patients, public, police and families at risk:

  1. People with mental illness who are being released from Involuntary Treatment (i.e, were already danger to self or others) are not being evaluated by hospitals for inclusion in Kendra’s Law or other community treatment.
  1. Mentally Ill Prisoners who are being released from jails and prisons (i.e, already committed a crime) are not being evaluated for inclusion in Kendra’s Law or other community treatment.
  1. Mentally Ill people who have previously attacked family members, are not being considered for Kendra’s Law or other community treatment, especially if the family has not reported attacks.

Why Do The Cracks Exist? No one wants responsibility for closing them

  • Hospital Officials don’t’ want to evaluate involuntarily committed mentally ill people prior to release for fear it will increase the length of their stay and require them to arrange for services.
  • Jails and Prison Officials don’t want to evaluate prisoners prior to release for fear it creates an additional obligation on them
  • Mental Hygiene Directors don’t want to receive reports from hospitals, prisons, jails or families of people who may need enrollment in Kendra’s Law because they don’t want to have to accept responsibility for these highly symptomatic, potentially dangerous individuals.
  • NYS OMH Commissioner does not want to receive reports from hospitals, prisons, jails or families about people who may need Kendra’s Law because they don’t want responsibility to provide treatment.
  • Mental Health Service Providers are afraid of losing the ability to cherry pick the easiest to treat for admission to their programs.

Since no one wants responsibility, individuals with serious mental illness are being sent to the streets, jails, prisons and morgues instead of treatment.

Solutions: Kendra’s Law reduces violence, arrest, incarceration, hospitalization, homelessness and suicide when used, but is not used for the most seriously ill because neither hospitals, prisons, jails, mental health directors of NYS OMH wants to accept responsibility. Here are ways to see it is used:

1. Put burden on hospitals and corrections: Require hospitals to evaluate involuntarily committed patients before discharges and  corrections to evaluate mentally ill prisoners prior to discharge and file petitions themselves. Or…

2. Put burden on Mental Hygiene Directors: Have hospitals report involuntarily committed patients who are being released; and correction officials report mentally ill prisoners being released; and families report dangerous loved-ones  to Mental Hygiene Directors and have Mental Hygiene Directors file the petition, if needed, themselves. Or,

3. Put burden on NYS OMH, Have reports of hospitals, corrections, and families go to OMH who can file petitions.

All these proposals have been rejected by the organizations that don’t want responsibility.

Providing services to the most seriously ill should be, the core function of mental hygiene directors and the office of mental health. Their raison d’etre. Unfortunately, this core function of providing services to the most seriously ill is often ignored in favor of providing services to others. This approach sends the most seriously ill to jails and prisons and puts public and police at risk. To counteract this, improvement of care for the most seriously ill almost always and exclusively has to be obtained by legislation or law suits. Kendra’s Law is one such piece of legislation. It not only allows courts to commit the seriously ill to accept treatment, it commits the mental health system to meeting their core responsibility of providing it. The Local Mental Hygiene Directors receive over $1 billion in aide to localities (ck) and have no obligation to spend it on most seriously ill. (“Funded Unmandate”).  So the legislature could justify not providing additional funds. This would help reorient the system towards the most seriously ill but cause dissent among those who benefit from the status quo.

B. The legislature could provide additional funding which could sweeten the pot which would lessen objections to accepting responsibility.


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.