EXPLANATORY NOTES

[i] “Assisted Outpatient Treatment”, also known as Kendra’s Law.

[ii] When the law was set to expire in 2005, to prevent the law from being renewed, opponents charged it was “racist.” Instead of making the law permanent, the legislature decided to renew it for five years and investigate the charge. The researchers at Duke University released their study in 2009.

“We find no evidence that the AOT Program is disproportionately selecting African Americans for court orders, nor is there evidence of a disproportionate effect on other minority populations. Our interviews with key stakeholders across the state corroborate these findings.”

What they defined as ‘racism’ was persons of color and Hispanics getting equal access to care. The number of individuals in Kendra’s Law is reflective of the number of people who receive public treatment and the presence of diversity in New York City, where AOT is used most often.

[iii] There is no minimum length of a court order in existing legislation. It allows initial court orders to be a maximum of 6 months. The Gunther/Young bills have no minimum term for court orders. They propose to increase the maximum allowable to one-year based on research by Duke University showing individuals in Kendra’s Law do better if they remain in the program for a year versus 6 months, and those improvements continue even after the order ends as long at the individual had been in Kendra’s Law for one-year.

[iv] Doctor testimony is required. The new bill gives the client and their court appointed lawyer the right to voluntarily stipulate to the doctors findings and waive the doctor’s personal appearance. Researchers at Duke Univ. found the medical issues and proposed treatment plan are not in dispute. and this provision could saves counties time and money.

[v] The new law codifies a court decision that “representative payee’ services may be ordered if they would benefit the patient. Usually this means paying their benefits to a third party who helps them manage their money so they have enough for housing, food, etc. and don’t use the money for drugs.

[vi] The bill fixes a crack in the mental health system whereby an individual who is in AOT may have their order expire without being considered for renewal.

[vii] The non-compliance must be substantial. In that case, since the individual is in material violation of a court order they can be taken to a hospital for an examination to see if assisted inpatient treatment is needed. If it is not, the patient is released.

[viii] An annual total of $32 million was allocated for the AOT program (Source: 2009 Duke Univ. Study).

[ix] The law was proposed before Ms. Webdale was pushed to her death. It was first proposed by families of the mentally ill in the 1980s. The law at that time required an individual to be “danger to self or others” before they could be treated over objection. Families wanted a law that would prevent dangerousness, rather than require it.  The law they suggested was piloted in NYS as the Bellevue Outpatient Commitment Pilot Program (starting around 1995). In 1999, when Ms. Webdale was pushed, the public safety benefits of the pilot program became apparent, and advocates for the mentally ill were joined by those in the public safety community, hospital workers, hospital associations and others. The result was the passage of Kendra’s Law.

[x] The law lists strict criteria the courts must find before individuals can be ordered into treatment. A finding of mental illness is not sufficient.

[xi] There are seven specific criteria that must be met before courts can order individuals to receive AOT. One of them is, 

in view of his or her treatment history and current  behavior,  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   person or others:

[xii] Medications are one of the services the courts may order patients to accept. The only mandated service is case management.

[xiii] Hospitalized and given medications to help alleviate his schizophrenia.

[xiv] After starting to deteriorate as a result of refusing to continue on his medications and in community-based treatment.

[xv] Andrew Goldstein turned up at hospitals after he went off medications. Many feel if he had been under court order to receive care, he would not have gone off treatment. In addition, and importantly, the law not only commits the individual to receive care, it commits the health system to provide it. Had he been under court order and needed care, there would have been an obligation to provide it and he might not have been turned away.

[xvi] We are unaware on what basis this claim is made.

[xvii] It is true that providers of mental health services often refuse to admit the most seriously ill to their programs. One of the more important components of Kendra’s Law is that it not only commits the individual to receive care, it “commits” the mental health system to provide treatment. Kendra’s Law helps improves the treatment systems response to the needs of the seriously ill. Researchers at Duke who conducted the study the legislature requested found:

·       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.

·       AOT has been instrumental in increasing accountability at all system levels regarding delivery of services to high need individuals. Community awareness of AOT has resulted in increased outreach to individuals who had previously presented engagement challenges to mental health service providers.

·       Processes and structures developed for AOT have resulted in improvements to treatment plans that more appropriately match the needs of individuals who have had difficulties using mental health services in the past.

Researchers at OMH found:

·       Improved Access to Services. AOT has been instrumental in increasing accountability at all system levels regarding delivery of services to high need individuals. Community awareness of AOT has resulted in increased outreach to individuals who had previously presented engagement challenges to mental health service providers.

·       Improved Treatment Plan Development, Discharge Planning, and Coordination of Service Planning. Processes and structures developed for AOT have resulted in improvements to treatment plans that more appropriately match the needs of individuals who have had difficulties using mental health services in the past.

·       Improved Collaboration between Mental Health and Court Systems. As AOT processes have matured, professionals from the two systems have improved their working relationships, resulting in greater efficiencies, and ultimately, the conservation of judicial, clinical, and administrative resources.

• There is now an organized process to prioritize and monitor individuals with the greatest need;

• AOT ensures greater access to services for individuals whom providers have previously been reluctant to serve;

• Increased collaboration between inpatient and community-based mental health providers.

[xviii] The development of Assisted Outpatient Treatment was based on the desire to help individuals with serious mental illnesses who are so ill, they cannot recognize they are ill (anosognosia).  It properly balances the civil rights of individuals with mental illness, their right to treatment, and the safety needs of the public. It is a more compassionate, less expensive than it’s alternative: involuntary inpatient commitment.

[xix] Most consumers who have experienced the program do not share the author’s opposition to Kendra’s Law.  In 2010, Researchers at Columbia University found:

Patients who underwent mandatory treatment reported higher social 
functioning and slightly less stigma, rebutting claims that mandatory 
outpatient care is a threat to self-esteem.



In 2009, researchers at Duke University found:

“Despite being under a court order to participate in treatment, current AOT recipients feel neither more positive nor more negative about their treatment experiences than comparable individuals who are not under AOT.”

In 2005, OMH researchers found:

·       87% of participants interviewed said they were confident in their case manager's ability to help them

·       88% said they and their case manager agreed on what is important for them to work on.

·       75% reported that AOT helped them gain control over their lives,

·       81% said AOT helped them get and stay well

·       90% said AOT made them more likely to keep appointments and take medication.

[xx] We don’t know where this statistic comes from or its relationship to Kendra’s Law. Researchers found Kendra’s Law recipients had a 55% reduction in suicide attempts or physical harm to self. This would be expected to, although it hasn’t been studied, to lead to an increase in life span, not a decrease.  kendraslaw.org  

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