By Jeff Keller
Assisted Outpatient Treatment, better known as Kendra’s Law, enables courts to order mandatory case management for individuals with a mental illness who do not accept treatment, are “at risk” of doing harm to themselves or others and are unlikely to survive safely in the community without supervision.

The law has now reached the middle of its current term. It was signed in August 1999, and unless it is renewed, it will sunset as of June 30, 2005. At this mid-point, the Office of Mental Health has issued Kendra’s Law: An Interim Report on the Status of Assisted Outpatient Treatment. The report shows some dramatic results from AOT.

From November 1999 through December 3, 2002, 7,938 individuals have been referred to local AOT coordinators for investigation to determine potential eligibility for an AOT court order. Thirty-three percent or 2,559 of these have resulted in petitions filed for the issuance of an AOT court order; of these, 95 percent or 2,433 resulted in a court order being issued. Twenty percent (1,541) of the total number of investigations have resulted in service enhancements rather than court orders.

Court orders and service enhancements have been issued in all regions of the state. Sixty-five percent of all court orders and service enhancements, and about 77 percent of all court orders, have occurred in New York City. More than half of all court orders (55 percent) have been renewed. The average “length of stay” in court-ordered status is nearly 11 months.

Seventy percent of those receiving an AOT court order have a diagnosis of schizophrenia; 13 percent have a diagnosis of bipolar disorder and 60 percent are reported as having a co-occurring mental illness and substance abuse condition with mental illness as the primary diagnosis. When compared with a similar population of mental health service recipients, persons under AOT were twice as likely to have had contact with the criminal justice system and 50 percent more likely to have had a previous episode of homelessness.

According to the report, after six months of AOT, the incidence of “significant events” in the lives of individuals in the program dropped considerably from their pre-AOT levels. For all AOT recipients, the incidence of psychiatric hospitalization dropped from 87 percent to 20 percent, the incidence of homelessness dropped from 21 percent to 3 percent, the incidence of arrests dropped from 30 percent to 5 percent, and the incidence of incarceration dropped from 21 percent to 3 percent.

Those exhibiting “poor engagement of services” went from 50 percent to 34 percent, and those exhibiting “poor medication adherence” went from 67 percent to 22 percent after six months.
Recipients also showed improved functioning in the areas of self-care, community living, interpersonal functioning and task performance. There were also statistically significant reductions in harmful behaviors such as substance abuse, suicide attempts and physical harm to self.

The report combined statewide statistical reports with in-depth studies of eight geographically representative counties and New York City. It found that important changes to local mental health systems have come about as a result of AOT, including enhanced accountability, improved access to services, improved treatment plan development and discharge planning, improved coordination of service planning and improved collaboration between the mental health and court systems.

Here is what the report says on accountability:

AOT has increased accountability at all levels regarding delivery of services to individuals who have high needs or who are at high risk to themselves or others. Community awareness of AOT has resulted in increased outreach to individuals who were previously difficult to engage (or had difficulty becoming engaged) in mental health services. By alerting local mental health systems to the potential risk posed by not responding to an individual’s situation, those systems improved their ability to mobilize around the needs of these individuals.

Kendra’s Law was extremely controversial when it was enacted. The OMH report shows that Assisted Outpatient Treatment had made a major difference for the better in many people’s lives. Not only that, but it has also improved local mental health systems to an extent that was largely unanticipated.

Credit is due to the OMH for making the program work so well. The state also deserves a lot of credit for committing the funding to build the “infrastructure” that has enabled the program to work. The state budget for Fiscal Year 2000-2001 included $32 million to implement AOT and $125 million, the single largest state investment in mental health to date, for “New Initiatives” funding to expand case management, Assertive Community Treatment and housing, to develop the Single Point of Access system and to increase the availability of other community services.
The report can be downloaded from the Office of Mental Health website: www.omh.state.ny.us. Click on “Initiatives” on the bar across the top of the page.

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