NYAPRS Note: Mandating treatment against an individual’s desires is a clear violation of their right to autonomy and choice. There are many reasons someone may decide to not engage in services, including past trauma or abuse while in the system and a lack of preferred service options. Resorting to forced treatment places the blame for lack of engagement on the individual and fails to hold the system accountable for providing an array of services which successfully engage individuals voluntarily.
New York State’s Kendra’s Law, or Assisted Outpatient Treatment (AOT), statute was renewed in 2023, with the requirement of a new study to evaluate the program, including whether court orders or improved voluntary services lead to better outcomes. Yesterday the NYS Office of Mental Health (OMH) announced the study contract was awarded to Human Services Research Institute.
We are advocating for the study to have a true comparison of those on court orders and those who received enhanced voluntary services as an alternative to determine whether Kendra’s Law outcomes are due to mandating treatment or increasing access to services. The most recent evaluation of the program, published in 2010, was unable to include this type of comparison because those who received enhanced services did not get the exact same services as those on court orders. We must get this data to scientifically determine whether improvements are due to court orders or enhanced services.
It must also evaluate whether local government and the state, as well as providers, are providing an array of voluntary services to people first and turning to court orders only as a last resort, as the law requires. Finally, the study must determine whether the failure to provide culturally aware services is responsible for the disproportionate use of AOT on people of color, who account for roughly 80% of orders in New York City.
We are hopeful this new study will accurately capture the effects of AOT in New York and support what we know, mandating treatment is not what leads to recovery, but rather increased access to appropriate services such as peer support, voluntary alternatives to hospitalization, mental health first responders, and housing with supports. Read below to learn more about the review and recently awarded contract.
NY’s Mental Health’s Assisted Outpatient Treatment Program to Undergo Review
By Lucas Day | Finger Lakes Daily News | October 5, 2023
The New York State Office of Mental Health has awarded $1 million to the Human Services Research Institute to conduct an extensive two-year review of its Assisted Outpatient Treatment Program, which was created following the passage of Kendra’s Law in 1999. The agency was tasked with conducting an independent evaluation as part of the five-year renewal of the law that was approved in the FY 2023 State Budget.
Starting in January 2024, Human Services Research Institute will design and develop the evaluation, collect, and analyze data, and submit a final report within two years. The evaluation will compare the treatment and health outcomes for individuals who have received court ordered community-based services with the treatment of those who receive a comprehensive package of voluntary services.
Court-ordered assisted outpatient treatment was implemented in New York State in 1999, with the goal of ensuring individuals with mental illness and a history of hospitalizations or violence get assistance while living in the community, even if they have previously been unwilling to engage in treatment. This program allows judges to order individuals to comply with treatment while also requiring the state and localities to ensure treatment and services outlined in a court-ordered treatment plan are adequately provided.
Local county governments and New York City are responsible for operating and supervising these programs, with their mental health directors investigating reports of individuals in need of assisted outpatient treatment, file petitions, and coordinating the delivery of court-ordered services. Program coordinators at each of OMH’s five field offices work with these local directors to monitor the program and the care they provided.
More than 20,000 unduplicated orders for assisted outpatient treatment have been issued statewide since November 1999. Counties have conducted more than 46,000 investigations to determine whether individuals met the statutory criteria for the program, and have filed more than 32,500 petitions, with about 95 percent of them ultimately being granted by the court.
Kendra’s Law was established in memory of Kendra Webdale, a young woman who died after being pushed in front of a subway train in New York City in January 1999. The man who pushed her had a history of mental illness and hospitalizations but was not receiving treatment at that time.
“We view the use of involuntary treatment orders as an infringement on people’s rights and, accordingly, expect the study to investigate whether a full array of proven voluntary and culturally responsive approaches is alternatively offered as a first resort, in compliance with Kendra’s Law,” New York Association of Psychiatric Rehabilitation Services CEO Harvey Rosenthal said. “This study must investigate whether state and local governments and inpatient and outpatient providers are sufficiently funding and providing enhanced services of this kind, including peer outreach, respite and first responder programs.”
The program has been reviewed several times over the past two decades, with reports being issued in 2005 and 2009. The latest study found that the program and increased services improved a range of important outcomes for its recipients.
To develop the framework for the evaluation, OMH’s Office of Advocacy and Peer Support Services conducted a series of focus groups earlier this year that were led by Upstate Bureau Director Regina Shoen, an individual with lived experience with the program. These focus groups gathered insight from individuals and families with personal experience, in addition to advocates and service providers.
“We were pleased to have worked with the community to ensure the perspective of individuals with lived experience in assisted outpatient treatment were central to the design and implementation of this important study,” Chief Advocacy Officer Amanda Saake said. “We take great pride in ensuring that the voices of the people involved with and impacted by this program and will continue to drive this process.”