Kendra's Law, effective since November 1999, is a New York State law concerning involuntary outpatient commitment, also known as assisted outpatient treatment. It grants judges the authority to issue orders that require people who meet certain criteria to regularly undergo psychiatric treatment. Failure to comply can result in inpatient commitment for up to 72 hours. Kendra's Law does not mandate that patients be forced to take medication.
It was originally proposed by members of the National Alliance on Mental Illness, the Alliance on Mental Illness of New York State, and many local NAMI chapters throughout the state. They were concerned that laws were preventing individuals with serious mental illness from receiving care until after they became "dangerous to self or others". They viewed outpatient commitment as a less expensive, less restrictive and more humane alternative to inpatient commitment.
The members of NAMI, working with NYS Assemblywoman Elizabeth Connelly, NYC Department of Mental Health Commissioner Luis Marcos, and Howard Telson were successful in getting a three-year pilot commitment program started at Bellevue Hospital. When the Bellevue Outpatient Commitment Program came to an end, Attorney General Eliot Spitzer, the Treatment Advocacy Center and mental health advocate DJ Jaffe put together a coalition to pass a statewide law. It was based on the same concept as the Bellevue Outpatient Commitment Program but with important differences.
Background In 1999, there were a series of incidents involving individuals with untreated mental illness becoming violent. In one assault in the New York City Subway, Andrew Goldstein, 29 and diagnosed with schizophrenia but off medication, pushed Kendra Webdale into the path of an oncoming N train at the 23rd Street station. Goldstein had recently attempted to get treatment but had been turned away. Webdale's family joined a coalition led by Governor Pataki, the Treatment Advocacy Center and Jaffe, and the family played a significant role in getting the law passed. Subsequently, in a similar incident, Julio Perez, age 43, pushed Edgar Rivera in front of an uptown 6 train at 51st Street. Rivera lost his legs and became a strong supporter of the law. Kendra's Law, introduced by Pataki, was created as a response to these incidents.McMan's Depression and Bipolar Web, "Kendra's Law", In 2005, the law was extended for five years.New York Civil Liberties Union, "State Lawmakers Extend Kendra's Law For 5 Years, Despite Concerns That It Targets Men Of Color"
As a result of these incidents, involuntary outpatient commitment moved from being seen as a program to help people with mental illness to a program that could increase public safety. Public safety advocates joined in trying to take the Bellevue Pilot Program statewide. What was formerly known as involuntary outpatient commitment was renamed euphemistically as "assisted outpatient treatment", in an attempt to imply a positive intent of the law.
Criteria Kendra's Law allows courts to order certain people diagnosed with mental illness to attend treatment as a condition for living in the community. The law is aimed at those who have a pattern of not following treatment recommendations which has resulted in hospitalization, or violent behaviors placing the patient or others as serious risk of physical harm.Mental Hygiene Law 9.60
In order to be subjected to Kendra's Law, individuals must meet the following criteria established in Section 9.60 of NYS Mental Health Law. A patient may be ordered to obtain assisted outpatient treatment if the court finds by clear and convincing evidence that: the patient is eighteen years of age or older; and the patient is suffering from a mental illness; and the patient is unlikely to survive safely in the community without supervision, based on a clinical determination; and the patient has a history of lack of compliance with treatment for mental illness that has: at least twice within the last thirty-six months been a significant factor in necessitating hospitalization in a hospital, or receipt of services in a forensic or other mental health unit of a correctional facility or a local correctional facility, not including any period during which the person was hospitalized or incarcerated immediately preceding the filing of the petition or; resulted in one or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the last forty-eight months, not including any period in which the person was hospitalized or incarcerated immediately preceding the filing of the petition; and the patient is, as a result of his or her mental illness, unlikely to voluntarily participate in the recommended treatment pursuant to the treatment plan; and in view of the patient's treatment history and current behavior, the patient is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in serious harm to the patient or others as defined in section 9.01 of this article; and it is likely that the patient will benefit from assisted outpatient treatment; and if the patient has executed a health care proxy as defined in article 29-C of the public health law, that any directions included in such proxy shall be taken into account by the court in determining the written treatment plan; and the treatment plan set forth is the least restrictive plan that is most likely to benefit the patient.
A patient can only be ordered to assisted outpatient treatment for a maximum 12-month period. The assisted outpatient treatment may be renewed by petition filed prior to the current order's expiration. Where the petition is for a renewal, the 36-month limit for hospitalizations and the 48-month limit for violent behavior do not apply.
Support The New York Times reported that "a study has found that a controversial program that orders these patients to receive treatment when they are not hospitalized has had positive results. Patients were much less likely to end up back in psychiatric hospitals and were arrested less often. Use of outpatient treatment significantly increased, as did refills of medication. Costs to the mental health system and Medicaid of caring for these patients dropped by half or more."
According to the Treatment Advocacy Center, the following organizations (in part or in full) support the law:
National Treatment Advocacy Center (TAC) American Psychiatric Nurses Association American Psychiatric Association National Alliance on Mental Illness (NAMI) National Sheriffs' Association National Crime Prevention Council
Statewide National Alliance on Mental Illness New York State (NAMI NYS) NYS Association of Chiefs of Police (NYSCOP)
Regional and local AMI-Friends of NYS Psychiatric Institute, NYC NAMI/Familya of Rockland County NAMI Schenectady NAMI Chautauqua County NAMI of Buffalo and Erie County NAMI of NYC/Staten Island NAMI Orange County NAMI Champlain Valley Harlem Alliance for the Mentally Ill NAMI of Montgomery, Fulton, Hamilton Counties NAMI/Albany Relatives NAMI North Country Albany County Forensic Task Force Westchester County Chiefs of Police Association Orange County Police Chiefs Association Town of New Windsor, police department Town of Chester, NY Police Department Town of Mechanicville, police department West Seneca, NY Police Department Broome County District Attorney
Selected individual supporters Xavier Amador – author, I am Not Sick, I Don't Need Help! Pete Early – author, Crazy: A Father's Search Through America's Mental Health Madness Rael Jean Isaac – co-author, Madness in the Streets Richard Lamb – Dept. of Psychiatry, USC Edgar Rivera – lost legs in subway pushing E. Fuller Torrey – author, Surviving Schizophrenia Pat Webdale – mother of Kendra Webdale Robert Yolken – Director of Developmental Neurovirology Johns Hopkins Univ. DJ Jaffe, Executive Dir. Mental Illness Policy Org.
Media editorial supporters New York Times Newsday New York Post Daily News Albany Times Union Buffalo News Troy News Office of the Attorney General NYS Public Employees Federation Greater NY Hospital Association Citizens Crime Commission Victim Services Agency Visiting Nurses Service Justice for All St. Francis Residence
Moreover, research specifically on Kendra's Law in New York State shows lower rates of violence, homelessness, arrest, incarceration, and cost. It shows that those who support Kendra's Law say it helps them get well and stay well. Research in other states that have assisted outpatient treatment programs has also shown positive results.All Studies on Assisted Outpatient Treatment (AOT)
Courts have ruled that Kendra's Law does not violate rights, citing the narrow criteria, the fact that the law does not provide for medication over objection ("force") and the government interest in reducing violence.
Supporters note that the system in the United States is so different from that in the U.K. that studies that aggregate community treatment orders (CTOs) used in the U.K. and elsewhere overseas with Kendra's Law as practiced in the U.S. do not give as accurate a picture as studies exclusively on Kendra's Law. They note that the Cochrane Study quoted by opponents of assisted outpatient treatment did not include any of the studies on Kendra's Law, or assisted outpatient treatment as practiced in other states, and only included a pilot program, the Bellevue Outpatient Commitment Program, that was never taken statewide.
In addition, the New York Times reported on Kendra's Law: the "program that orders these patients to receive treatment when they are not hospitalized has had positive results. Patients were much less likely to end up back in psychiatric hospitals and were arrested less often. Use of outpatient treatment significantly increased, as did refills of medication. Costs to the mental health system and Medicaid of caring for these patients dropped by half or more."
Opposition
Kendra's Law is opposed for different reasons by many groups, most notably the anti-psychiatry movement and the New York Civil Liberties Union. Opponents say that the law has harmed the mental health system, because it can deter people from seeking treatment.Testimony: Extending Kendra's Law. Statement Of Beth Haroules Before The Assembly Standing Committee On Mental Health, Mental Retardation And Developmental Disabilities And The Assembly Standing Committee On Codes regarding New York State's Assisted Outpatient Treatment (AOT) Program The implementation of the law is also criticized as being racially and socioeconomically biased.New York Lawyers for the Public Interest, Inc., "Implementation of Kendra's Law is Severely Biased" (April 7, 2005) (PDF)
Studies A 2017 Cochrane systematic review of the literature, that included three relatively small randomized controlled trials, did not find significant differences in the use of services, social functioning, or quality of life when comparing compulsory community treatment with standard voluntary care or brief supervised discharge. The systematic review did report that people who receive compulsory community treatment may be less likely to be victims of crime, both violent and non-violent.
A randomized, controlled trial published in the Lancet concluded, "the imposition of compulsory supervision does not reduce the rate of readmission of psychotic patients. We found no support in terms of any reduction in overall hospital admission to justify the significant curtailment of patients' personal liberty."