Alliance Alert: The Alliance for Rights and Recovery is encouraged to see the findings of New York’s independent evaluation of Kendra’s Law receiving the attention they deserve. The report makes one conclusion abundantly clear: people improve when they receive timely access to high-quality, intensive community-based services. While individuals receiving Assisted Outpatient Treatment (AOT) experienced significant improvements, those receiving voluntary Assertive Community Treatment (ACT) achieved comparable results, with outcomes that were the same or better than the AOT group on six of the ten key measures examined. Researchers repeatedly concluded that the benefits people experienced came from access to services such as housing, case management, transportation, and intensive treatment, not from the court order itself. They also found that expanding voluntary service pathways would likely reduce the use of court-ordered treatment.
Just as importantly, the evaluation documents serious concerns about the harms associated with the current AOT system. Participants described limited due process, little meaningful involvement in treatment planning, a lack of information about voluntary alternatives, and feelings of lost agency and control. Researchers also identified troubling racial disparities in the use and enforcement of AOT, including disproportionate impacts on Black New Yorkers, and called for stronger civil rights protections, improved legal advocacy, greater system accountability, and less reliance on coercive practices. These findings demonstrate that New York should not simply extend or make Kendra’s Law permanent. Instead, the state should implement the researchers’ recommendations by expanding voluntary access to housing, peer support, and other intensive community-based services so people can receive help quickly, without first entering the court system.
These important conversations will continue at the Alliance for Rights and Recovery’s 44th Annual Conference, where we will host a major panel examining Kendra’s Law and the statewide evaluation. The session will feature members of the research team who conducted the evaluation, and leading advocates discussing what these findings mean for the future of New York’s mental health system. Additional workshops throughout the conference will explore the policy and system improvements needed to create a more responsive, recovery-oriented services system for everyone.
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Independent New York State Evaluation Questions Reliance on Kendra’s Law
Valerie A. Canady | Mental Health Weekly | August 14, 2026
A major report commissioned by New York State is urging policymakers to strengthen and prioritize voluntary mental health services rather than rely on court-ordered treatment, concluding that people can achieve comparable outcomes when they have access to intensive community-based supports without being placed under assisted outpatient treatment (AOT).
The report comes as Kendra’s Law approaches its June 30, 2027, sunset date, when the state legislature will again decide whether to renew the court-ordered outpatient treatment program.
Enacted in 1999, Kendra’s Law allows courts to order community-based treatment for certain individuals with serious mental illness. The law was named for Kendra Webdale, who was killed after being pushed in front of a New York City subway train by a man with a history of mental illness and psychiatric hospitalization. The law is subject to periodic legislative renewal.
The New York State Office of Mental Health (OMH) contracted Human Services Research Institute and the University of Pittsburgh School of Social Work to conduct an independent evaluation of AOT policy and outcomes. The 400-page report, “Independent Evaluation of New York State Assisted Outpatient Treatment, Final Report,” was published in June.
Report Methodology, Approach
The evaluation team held virtual and in-person consultation meetings during the early stages of designing the evaluation and prior to data collection. The team held 30 consultation meetings with 114 people representing different types of perspectives, including administrators, providers, family members, supporters of people on AOT, legal system professionals, advocates and people with lived experience. The team also conducted at least one site visit in each of the five regions in New York State.
Findings
The clearest and most consistent result is that positive outcomes are driven by access to needed services — such as assertive community treatment, housing support, case management, Health Home Plus, and transportation support — all of which are available voluntarily with comparable outcomes, the evaluation team stated.
Qualitative findings revealed widespread concerns about coercion and limited personal choice. Individuals under AOT often said they adhered to medication regimens or participated in services out of fear of potential consequences rather than agreement with their treatment plans. Many entered AOT following a psychiatric hospitalization or criminal justice involvement, with little discussion of less restrictive alternatives, the report indicated.
Many people under AOT reported they did not understand how or why orders are extended and have experienced renewals as automatic, contributing to a sense of indefinite oversight, the report stated. The threat of removal to a hospital — though rarely enacted — plays a central role in maintaining compliance, report authors noted. System-level findings also point to two inconsistencies in implementation: gaps in data systems, and disparities in experiences, including disproportionate impacts of enforcement practices on people of color.
Quantitative results also suggest that outcomes could be improved by increasing access to psychosocial rehabilitation and Health Home Plus services to AOT clients and by routinizing outpatient follow-up visits at least within a month after emergency department visits and hospital discharges, the report started.
“On the whole, these findings suggest that efforts to encourage utilization of voluntary services and better inform people meeting AOT eligibility criteria about voluntary options will likely divert a substantial number from court-mandated treatment,” the evaluation team wrote.
The evidence suggests that AOT’s primary benefit is improving access to services, and its legal framework raises ongoing concerns about fairness, voice and agency. Researchers concluded that stronger voluntary service pathways could achieve similar outcomes with fewer harms and recommended strengthening procedural protections.
Due Process Concerns
One of the major concerns identified in the report was the lack of robust procedural due process protections, said Nev Jones, Ph.D., a co-author of the evaluation and associate professor and director of PathLab at the University of Pittsburgh School of Social Work. People’s rights are being compromised through the AOT process when they waive their rights to a hearing and are not coming forward to meet with a judge, she noted. “Both were common and often not an informed or meaningful choice,” Jones told MHW. “People described the process as predetermined, occurring under threat of adverse consequences and often in the context of crisis and hospitalization; they didn’t understand what they were waiving, or weren’t aware of a proceeding, especially at renewal.”
She added, “Whether that’s a rights violation is a legal question; what we found is that the protections often didn’t function, in practice, as substantive due process.”
Jones said she and her co-team documented the benefits and harms of AOT. “The benefits were overwhelmingly attributed to access to services and supports, including housing, rather than from the coercion (court mandate) itself,” she said. “Those supports could in principle be delivered voluntarily.”
Key Recommendations
Among the report’s recommendations are:
- Guarantee access to records within five business days for people subject to AOT orders, including petitions, psychiatric evaluations, treatment plans, court orders and service records.
- Develop clearer procedures for ending AOT orders and increase individuals’ involvement in treatment planning.
- Establish stronger safeguards for those lacking decision-making capacity, while adopting higher standards for people deemed capable of making informed treatment decisions.
- Create mandatory practice standards for Mental Hygiene Legal Service and provide additional resources to support legal representation.
- Expand education and support for family members and other chosen supporters.
More broadly, the recommendations aim to strengthen civil rights protections, improve treatment quality, enhance system accountability and reduce regional variation in how AOT is implemented across New York State.
The most consistent theme in the report was coercion, said Jones. “It was nearly universal — the order and the possibility of hospitalization were an ever-present backdrop — and the benefits people valued came from services and supports (housing, treatment, case management), not from the mandate (i.e. the involuntary court order),” she said.
Jones said AOT orders can have consequences that extend well beyond mental health treatment. Depending on an individual’s circumstances, participation in the program may affect divorce proceedings, immigration proceedings, custody hearings and reported loss of licenses (e.g., license to practice law).
She also pointed to what she described as a second category of harm: neglect. “People want to get back on their feet and build meaningful lives,” she said, stressing the need for greater investment in recovery and rehabilitation services.
Strengthening procedural protections within the court process should also be a priority, according to Jones. “We heard a lot of concerns about Mental Hygiene Legal Service,” she said. Some participants told researchers that calls with attorneys lasted only a few minutes before a hearing or that they were encouraged to sign paperwork rather than contest the petition.
“We really need to take a deeper look at what’s happening,” Jones said, noting that policymakers should take potential harms associated with AOT seriously.
State Response
Though the report’s authors raised concerns about due process, autonomy and the use of court-ordered treatment, OMH officials highlighted findings they said support AOT’s continued role in the state’s mental health system.
“This report illustrates how assisted outpatient treatment is positively impacting the very outcomes it was designed to address — reducing hospitalizations and improving community safety,” Justin Mason, OMH spokesperson told MHW. “Compared with individuals voluntarily receiving intensive community-based services, individuals on AOT experienced better outcomes related to improved housing stability, reduced risk of harm to others, reduced risk of psychiatric hospitalization, and reduced length of psychiatric hospitalization.”
Mason added, “We will continue to review the findings and recommendations to ensure this small but critical component of our state’s outpatient community-based care system continues fulfilling the key role it plays in our continuum of care.”
Advocates’ perspective
New York advocates said the report’s findings reinforce what they have long argued: Recovery is driven by access to high-quality, intensive community-based services, not coercion.
“We’re grateful this issue is so front and center, by the public, media, policymakers, providers and others,” Harvey Rosenthal, CEO of the Alliance for Rights and Recovery, told MHW. “This has been a controversial issue for 50 years. This is about connecting people with supports and services that work. I’m hopeful.”
Rosenthal noted that this independent evaluation of the state’s AOT program is only the second evaluation since Kendra’s Law was enacted in 1999. The first evaluation was conducted by Duke Health researchers (see “New study touts New York State’s AOT benefits, challenges,” MHW, Oct. 18, 2010; https://doi.org/10.1002/mhw.20254).
“We have never seen studies where they tried to compare voluntary services with court-ordered treatment,” Luke Sikinyi, vice president of public policy for the Alliance for Rights and Recovery, told MHW. “For people who have gone through AOT, their rights are not protected. They have received no information about their options. Many believe — incorrectly — that the only way to receive services is through a court order.”
He also pointed to what he described as persistent racial disparities under Kendra’s Law. According to Sikinyi, a disproportionate share of program participants are people of color, and Black and Brown individuals are more likely to be transported by police than their White or Hispanic counterparts. “The program shows continuing discrimination against people of color,” he said.
Rosenthal noted that Kendra’s Law is subject to legislative renewal every five years. Given the report’s findings and recommendations, he expressed hope that policymakers would use the next five-year period to implement and evaluate alternatives that emphasize voluntary, community-based supports.