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 [2], 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 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, age 29, while off medicines, pushed Kendra Webdale to her death in front of an oncoming NYC subway train. The law is named after her. Her family played a significant role in getting it passed. Subsequently Julio Perez, age 43, pushed Edgar Rivera onto the subway tracks. He lost his legs and became a strong supporter of the law. Both men had been dismissed 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. In 2005, the law was extended for 5 years.

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.

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 to help a small group who have a history of rehospitalization that is associated with going off medications because they have horrible side effects.

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 or hatred of miserable drug side effects, 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.

According to the Treatment Advocacy Center (treatmentadvocacycenter.org) all the following organizations support the law:

   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 Chataqua 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

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

Studies

As a result of the opposition to Kendra's Law, two studies were conducted on Kendra's Law. One was released in 2005[ and one in 2009.

The 2005 study found:

Specifically, the Office of Mental Health (OMH) study found that for those in the Assisted Outpatient Treatment (AOT) program:

• 74 percent fewer recipients experienced homelessness;
• 77 percent fewer recipients experienced psychiatric hospitalization;
• 83 percent fewer recipients experienced arrest; and
• 87 percent fewer recipients experienced incarceration.

Comparing the experience of AOT recipients over the first six months of AOT to the same period immediately prior to AOT, the OMH study found:

• 55 percent fewer recipients engaged in suicide attempts or physical harm to self;
• 49 percent fewer recipients abused alcohol;
• 48 percent fewer recipients abused drugs;
• 47 percent fewer recipients physically harmed others;
• 46 percent fewer recipients damaged or destroyed property; and
• 43 percent fewer recipients threatened physical harm to others.

As a component of the OMH study, researchers with the New York State Psychiatric Institute and Columbia University conducted face-to-face interviews with 76 AOT recipients to assess their opinions about the program and its impact on their quality of life. The interviews showed that after receiving treatment, AOT recipients overwhelmingly endorsed the program:

• 75 percent reported that AOT helped them gain control over their lives;
• 81 percent said that AOT helped them to get and stay well; and
• 90 percent said AOT made them more likely to keep appointments and take medication.

Additionally, 87 percent said they were confident in their case manager's ability to help them—and 88 percent said that they and their case manager agreed on what is important for them to work on. AOT had a positive effect on the therapeutic alliance.

In 2009, an independent study by Duke University into alleged racism found "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."

 Current status

Kendra's Law is set to expire in June 2015 unless it is renewed.

Current status[edit]

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