Kendra's Law

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 medication, 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.[7] A patient may be ordered to obtain assisted outpatient treatment if the court finds that:

  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

Support

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

National

Statewide

Regional/local

Selected individual supporters

Founding supporters

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.[8] The implementation of the law is also criticized as being racially and socioeconomically biased.[8][9]

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".[10]

John M. Grohol, PsyD, 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)."[11]

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.[12]

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:[13]

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%

A 2009 study, New York State Assisted Outpatient Treatment Evaluation done by Duke University, Policy Research Associates, University of Virginia, found:[14]

  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)

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:[15]

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:[16]

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

On January 15, 2013, New York Governor Andrew Cuomo signed into law a new measure that extends Kendra's Law through 2017.[17]

See also

References

  1. ↑
  2. ↑ Schapiro, Rich (2012-12-05). "Horrifying subway homicide causes parents to relive daughter's death". NY Daily News. Retrieved 2015-10-27.
  3. ↑ Jacobs, Andrew (1999-06-03). "Subway Victim Says He Harbors No Anger". The New York Times. Retrieved 2015-10-27.
  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. ↑
  8. 1 2 http://www.nyclu.org/content/testimony-extending-kendras-law 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
  9. ↑ New York Lawyers for the Public Interest, Inc., "Implementation of Kendra's Law is Severely Biased" (April 7, 2005) (PDF)
  10. ↑ Manning, Sanchez (14 April 2013). "'Psychiatric Asbos' were an error says key advisor". The Independent (London). Retrieved 30 May 2013.
  11. ↑ Grohol, John. "The Double Standard of Forced Treatment". PsychCentral. Retrieved 30 May 2013.
  12. ↑ "Court Nixes Albuquerque Ordinance On Mentally Ill". Associated Press. 5 August 2008. Retrieved 30 May 2013.
  13. ↑ 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
  14. ↑ Swartz, Marvin (2009-06-30), "New York State Assisted Outpatient Treatment Program Evaluation" (PDF), Office of Mental Health NY, retrieved 2010-10-27
  15. ↑ 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
  16. ↑ Burns, Thomas; Jorun Rugkåsa; Andrew Molodynski; John Dawson; Ksenija Yeeles; Maria Vazquez-Montes; Merryn Voysey; Julia Sinclair; Stefan Priebe (11 May 2013). "Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial.". THE LANCET 381 (9878): 1627–1633. doi:10.1016/S0140-6736(13)60107-5. PMID 23537605.
  17. ↑ "N.Y. governor signs nation's first gun-control bill since Newtown - CNN.com". CNN. 28 January 2013.

External links

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