Olmstead requires states to make greater use Assisted Outpatient Treatment

Issue: Olmsted v. L.C., Held: Title II of the ADA requires services to be provided in the “most integrated setting appropriate to the needs of the disabled, considering available resources.”

Assisted Outpatient Treatment (AOT/Kendra’s Law / Laura’s Law) helps people move from non-integrated settings to more integrated settings. States have the available resources to implement AOT. Therefore states must implement Assisted Ouptatient Treatment.

Olmstead recognized that the lack of medication compliance can be a problem:

“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))

People with serious mental illness are not living in non-integrated settings

  1. About 300,000 Americans with mental illness are living in jails and prisons
  2. About 50,000 Americans with mental illness are living in psychiatric hospitals

AOT helps people live in less restrictive environments:

Ex. In NYS Kendra’s Law reduced the use of restrictive settings

  • 77% fewer experienced psychiatric hospitalization
  • 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.
  • 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 groupt.
  • (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.

Ex. In California Laur’as Law decreased the use of restrictive settings

  • Hospitalization was reduced 46%;
  • Incarceration reduced 65%;

AOT has lowered the use of restrictive settings in other states

“States have “available resources”

  • States spend about $85 Billion on mental health (SAMHSA)
  • AOT can self-fund. Every dollar invested in AOT saves money
    • CA saved $1.81 for every dollar invested
    • AOT saved NYS over $100 million.
  • There is massive waste in system that could be used for AOT
    • Ex. $665 million of NYS Mental Health budget (1/3) was 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.” http://www.huffingtonpost.com/lloyd-i-sederer-md/patient-care-managing-high-need_b_8134
    • Ex. In California large amounts of Proposition 63/MHSA funds intended for seriously mentally ill are being diverted elsewhere

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.


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.