Kendra's Law

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Kendra's Law, effective since November 1999, is a New York State law concerning involuntary outpatient commitment. It grants judges the authority to issue orders that require people who meet certain criteria to regularly undergo psychiatric treatment. Failure to comply could result in commitment for up to 72 hours. Kendra's Law does not require that patients are forced to take medication.

It was originally proposed by members of the National Alliance on Mental Illness,[1] 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 felt the law should work to prevent violence, not require it. 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, Dr. Luis Marcos, and Dr. Howard Telson were successful in getting a pilot outpatient commitment program started at Bellevue Hospital.

Background

In 1999, there was a series of incidents involving individuals with untreated mental illness becoming violent. In two similar assaults in the New York City Subway, a man diagnosed with schizophrenia pushed a person into the path of an oncoming train. Andrew Goldstein, then 29, while off medicines, pushed Kendra Webdale to her death in front of an oncoming N train at the 23rd Street station.[2] The law is named after her. Her family played a significant role in getting it passed. Subsequently Julio Perez, age 43, pushed Edgar Rivera in front of an uptown 6 train at 51st Street.[3] Rivera lost his legs and became a strong supporter of the law. Both Goldstein and Perez had been discharged by psychiatric facilities with little or no medication. Kendra's Law, introduced by Governor George E. Pataki, was created as a response to these incidents.[4] In 2005, the law was extended for 5 years.[5]

As a result of these incidents, involuntary outpatient commitment moved from being a program to help the mentally ill to a program that could increase public safety. Public safety advocates joined advocates for the mentally ill in trying to take the successful Bellevue Pilot Program statewide. What was formerly known as involuntary outpatient commitment was re-christened as assisted outpatient treatment, in an attempt to communicate the positive intent of the law.[6]

Criteria

Kendra's Law basically allows courts to order certain seriously mentally ill individuals to accept treatment as a condition for living in the community. The law is aimed at a small group who have a history of rehospitalization that is associated with going off medications.

In order to be admitted to Kendra's Law, individuals must meet the following criteria established in Section 9.60 of NYS Mental Health Law :

Criteria for assisted outpatient treatment. A patient may be ordered to obtain assisted outpatient treatment if the court finds 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:
  1. 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;
  2. 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.

Support

According to the Treatment Advocacy Center (treatmentadvocacycenter.org), the following organizations (in part or in full) support the law [citation needed]:

National

  • Treatment Advocacy Center (TAC)
  • American Psychiatric Nurses Association
  • American Psychiatric Association
  • National Alliance for the Mentally Ill (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/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

  • Pat Webdale – Mother of Kendra Webdale
  • Dr. E. Fuller Torrey – Author, Surviving Schizophrenia
  • Dr. Xavier Amador – Author, I am Not Sick, I Don't Need Help!
  • Rael Jean Isaac – Co-author Madness in the Streets
  • Pete Early – Author, Crazy: A Father's Search Through America’s Mental Health Madness
  • Dr. Robert Yolken – Director of Developmental Neurovirology Johns Hopkins Univ.
  • Dr. Richard Lamb – Dept. of Psychiatry, USC
  • Edgar Rivera – Lost legs in subway pushing

Founding 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
  • E. Fuller Torrey, founder of the Treatment Advocacy Center, lobbied heavily in support of Kendra's Law.

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 scare patients away from seeking treatment.[7] The implementation of the law is also criticized as being racially and socioeconomically biased.[7][8]

Tom Burns, the psychiatrist who originally advised the United Kingdom's government on United Kingdom's Laws that are similar to Kendra's Law, has also come to the conclusion they are ineffective and unnecessary. Professor Burns, once a strong supporter of the new powers, said he has been forced to change his mind after a study he conducted proved the orders "don't work".[9]

John M. Grohol, PSY.D, in his article "The Double Standard of Forced Treatment", says "Forced treatment for people with mental illness has had a long and abusive history, both here in the United States and throughout the world. No other medical specialty has the rights psychiatry and psychology do to take away a person’s freedom in order to help “treat” that person. Historically, the profession has suffered from abusing this right — so much so that reform laws in the 1970s and 1980s took the profession’s right away from them to confine people against their will. Such forced treatment now requires a judge’s signature. But over time, that judicial oversight — which is supposed to be the check in our checks-and-balance system — has largely become a rubber stamp to whatever the doctor thinks is best. The patient’s voice once again threatens to become silenced, now under the guise of “assisted outpatient treatment” (just a modern, different term for forced treatment)."[10]

The New Mexico Court of Appeals declared an Albuquerque ordinance, modeled after Kendra's Law, requiring treatment for some mentally ill people conflicts with state law and can't be enforced.[11]

Studies

As a result of the opposition to Kendra's Law, two studies were conducted on Kendra's Law and found favorable outcomes. One study of Assisted Outpatient Treatment within the United States and another study done by a previous proponent of AOT type laws in the United Kingdom did not.

A 2005 study, Kendra's Law A Final Report on the Status of Assisted Outpatient Treatment done by New York State's Office of Mental Health, found:[12]

Reduced Incidence of Harmful Behaviors Percent of Persons with One or More Events Reported in the Past 90 Days
Percent of Assisted Outpatient Treatment (AOT) Recipients with Harmful Behaviors
   At Onset of AOT Court Order At Six Months Percent Reduction in Harmful Behaviors
Physically Harm Self/Made Suicide Attempt 9% 4% 55%
Abuse Alcohol 45% 23% 49%
Abuse Drugs 44% 23% 48%
Threaten Suicide 15% 8% 47%
Physically Harm Others 15% 8% 47%
Damage or Destroy Property 13% 7% 46%
Threaten Physical Harm 28% 16% 43%
Create Public Disturbances 24% 15% 38%
Verbally Assault Others 33% 21% 36%
Theft 7% 5% 29%
Average Percent Reduction     44%

(Table taken directly from source and converted to Wikipedia Table Template)

A 2009 study, New York State Assisted Outpatient Treatment Evaluation done by Duke University, Policy Research Associates, University of Virginia, found:[13]

  No current or recent AOT (n=134) Current AOT (n=115)
Outcome events (past six months) N % N %
Violent behavior 21 (15.7) 12 (10.4)
Suicidal thoughts or attempts 22 (16.4) 17 (14.8)
Homelessness 13 (9.7) 6 (5.2)
Involuntary commitment 54 (43.2) 46 (41.4)
Mental health pick-up/removal 25 (18.7) 16 (13.9)

(Table taken directly from source and converted to Wikipedia Table Template)

The study, Compulsory community and involuntary outpatient treatment for people with severe mental disorders by Steve R Kisely, Leslie Anne Campbell, Neil J Preston published at The Cochrane Library found:[14]

We identified two randomised clinical trials (total n = 416) of court-ordered 'Outpatient Commitment' (OPC) from the USA. We found little evidence that compulsory community treatment was effective in any of the main outcome indices: health service use (2 RCTs, n = 416, RR for readmission to hospital by 11-12 months 0.98 CI 0.79 to 1.2); social functioning (2 RCTs, n = 416, RR for arrested at least once by 11-12 months 0.97 CI 0.62 to 1.52); mental state; quality of life (2 RCTs, n = 416, RR for homelessness 0.67 CI 0.39 to 1.15) or satisfaction with care (2 RCTs, n = 416, RR for perceived coercion 1.36 CI 0.97 to 1.89). However, risk of victimisation may decrease with OPC (1 RCT, n = 264, RR 0.5 CI 0.31 to 0.8). In terms of numbers needed to treat (NNT), it would take 85 OPC orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest. The NNT for the reduction of victimisation was lower at six (CI 6 to 6.5). A new search for trials in 2008 did not find any new trials that were relevant to this review.

The study, Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial done by Professor Tom Burns DSc, Jorun Rugkåsa PhD, Andrew Molodynski MBChB, John Dawson LLD, Ksenija Yeeles BSc, Maria Vazquez-Montes PhD, Merryn Voysey MBiostat, Julia Sinclair DPhil, and Professor Stefan Priebe FRCPsych found:[15]

Of 442 patients assessed, 336 patients were randomly assigned to be discharged from hospital either on CTO (167 patients) or Section 17 leave (169 patients). One patient withdrew directly after randomisation and two were ineligible, giving a total sample of 333 patients (166 in the CTO group and 167 in the Section 17 group). At 12 months, despite the fact that the length of initial compulsory outpatient treatment differed significantly between the two groups (median 183 days CTO group vs 8 days Section 17 group, p<0·001) the number of patients readmitted did not differ between groups (59 [36%] of 166 patients in the CTO group vs 60 [36%] of 167 patients in the Section 17 group; adjusted relative risk 1·0 [95% CI 0·75—1·33]).

Current status

Jan. 15, 2013 - New York Governor Andrew Cuomo signed into law a new package of gun regulations, including a new measure that extends Kendra's Law through 2017.[16]

See also

References

  1. ↑
  2. ↑ "Horrifying subway homicide causes parents to relive death of daughter hurled to her death in January 1999"
  3. ↑ Subway Victim Says He Harbors No Anger
  4. ↑ McMan's Depression and Bipolar Web, "Kendra's Law", http://www.mcmanweb.com/article-66.htm
  5. ↑ New York Civil Liberties Union, "State Lawmakers Extend Kendra's Law For 5 Years, Despite Concerns That It Targets Men Of Color" http://www.nyclu.org/aot_program_pr_062305.html
  6. ↑
  7. ↑ 7.0 7.1 NYCLU Testimony On Extending Kendra's Law: Finally, there are some who argue that had Andrew Goldstein been assigned early on -- before he had assaulted at least 13 women -- to the criminal justice system rather than the mental health system in New York, that he would have been incarcerated and unable to attack Kendra Webdale. http://www.nyclu.org/content/testimony-extending-kendras-law
  8. ↑ New York Lawyers for the Public Interest, Inc., "Implementation of Kendra's Law is Severely Biased" (April 7, 2005) (PDF)
  9. ↑ Manning, Sanchez (14 April 2013). "'Psychiatric Asbos' were an error says key advisor". The Independent (London). Retrieved 30 May 2013. 
  10. ↑ Grohol, John. "The Double Standard of Forced Treatment". PsychCentral. Retrieved 30 May 2013. 
  11. ↑ "Court Nixes Albuquerque Ordinance On Mentally Ill". Associated Press. 5 August 2008. Retrieved 30 May 2013. 
  12. ↑ Carpinello, Sharon (March 2005), "Kendra's Law Final Report on the Status of Assisted Outpatient Treatment", Office of Mental Health NY, retrieved 2010-10-27 
  13. ↑ Swartz, Marvin (06-30-09), "New York State Assisted Outpatient Treatment Program Evaluation", Office of Mental Health NY, retrieved 2010-10-27 
  14. ↑ Kisely, Steve (February 2011), "Compulsory community and involuntary outpatient treatment for people with severe mental disorders", The Cochrane Collaboration, doi:10.1002/14651858.CD004408.pub3, retrieved 2013-05-30 
  15. ↑ Burns, Thomas; Jorun Rugkåsa, Andrew Molodynski, John Dawson, Ksenija Yeeles, Maria Vazquez-Montes, Merryn Voysey, Julia Sinclair, Stefan Priebe (11 May 2013). THE LANCET 381 (9878): 1627–1633. doi:10.1016/S0140-6736(13)60107-5. PMID 23537605. 
  16. ↑ "N.Y. governor signs nation's first gun-control bill since Newtown - CNN.com". CNN. 28 January 2013. 

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