Monday, March 07, 2005


TAC Newsletter March 4, 2005


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March 4, 2005


Today's E-news is one of the shortest we've had; it is also one of the most important ever.

The Treatment Advocacy Center's first legislative campaign was the one for Kendra's Law in 1999, which brought assisted outpatient treatment (AOT) to New York. This week, that state's office of mental health released a report on the first five years of its AOT program; it is by far the most comprehensive statewide examination to date of court-ordered community treatment. And the results of AOT in New York are astounding, astounding in how much better the program has made the lives of thousands who before were among those most severely ill with mental illness.

We ask you to please read the new Kendra's Law report - it is the single best tool for advocates seeking to either gain or increase the use of AOT in their states. If you are going to read only one mental health report this year, it should be this one. It is available on the NY OMH website at:

The Treatment Advocacy Center's briefing paper on the Kendra's Law report is below. You can also find it in its original formatting on our website at

Also on that page is a link to a PDF version, which will allow you to get an exact copy to distribute to the policy makers in your state and local community.



SUMMARY: Kendra's Law is New York's law for assisted outpatient treatment. The New York State Office of Mental Health released its "Final Report on the Status of Assisted Outpatient Treatment" on March 1, 2005, which details the outcomes for the first five years of Kendra's Law. Assisted outpatient treatment drastically reduced hospitalization, homelessness, arrest, and incarceration among the people with severe psychiatric disorders in the program, while at the same time increasing their adherence to treatment and overall quality of life. The adoption of assisted outpatient treatment also resulted in fundamental changes to the overall New York mental health system, leading to enhanced accountability and improved treatment plan collaboration for all service recipients - effectively committing the system to the patient, not just the patient to the system.

* * *

Kendra's Law Helps Those Who Need It Most

As of March 1, 2005, 3,908 individuals received treatment orders under Kendra's Law (note 1). An average of 62 individuals per month, or 747 individuals per year, were ordered to maintain treatment under the program (note 2).

As intended, the individuals placed in assisted outpatient treatment (AOT) were among the most severely ill. In the three years prior to the court order, almost every participant - 97 percent - had at least one psychiatric hospitalization (with an average of three hospitalizations per recipient). When compared with a similar population of mental health service recipients, those placed in AOT had been twice as likely to have been homeless, 50 percent more likely to have had contact with the criminal justice system, and 58 percent more likely to have a co-occurring mental illness and substance abuse condition.

Kendra's Law Reduces The Severest Consequences From Lack Of Treatment

As compared to the three years prior to participation in the program, AOT recipients experienced far less hospitalization, homelessness, arrest, and incarceration. Specifically, for those in the AOT program:

*** 74 percent fewer experienced homelessness;

*** 77 percent fewer experienced psychiatric hospitalization;

*** 83 percent fewer experienced arrest; and

*** 87 percent fewer experienced incarceration.

Kendra's Law Reduces Costs For The Most Expensive Services

Inpatient hospitalization is by far the most expensive form of psychiatric treatment available today. One of the most dramatic benefits to individuals participating in the Kendra's Law program was a marked reduction in the total number of days spent hospitalized. On average, AOT recipients spent 50 days in the hospital for psychiatric care during the six months prior to AOT, a number that was reduced 56 percent for participants during a matched period. Even after the termination of the court order, the decline continued - during the first six months following the end of the AOT order, total hospital days were reduced to an average of 13, a 73 percent reduction from the pre-AOT total. Individuals who meet Kendra's Law strict eligibility standard typically already consume significant inpatient and outpatient treatment dollars. Assisted outpatient treatment can reduce costs by reducing the ineffective use of existing services.

Kendra's Law Reduces Harmful Behavior

Kendra's Law also resulted in dramatic reductions in the incidence of harmful behaviors for AOT recipients at six months in AOT as compared to a similar period of time prior to the court order:

*** 55 percent fewer recipients engaged in suicide attempts or physical harm to self;

*** 49 percent fewer abused alcohol;

*** 48 percent fewer abused drugs;

*** 47 percent fewer physically harmed others;

*** 46 percent fewer damaged or destroyed property; and

*** 43 percent fewer threatened physical harm to others.

Kendra's Law Improves Medication Compliance

Individuals in the Kendra's Law program were also much more likely to regularly participate in services and take medication as prescribed by the treating physician.

*** The number of individuals exhibiting good adherence to medication increased by
51 percent (from 41 percent to 62 percent).

*** The number of individuals exhibiting good service engagement increased by 103 percent (from only 34 percent to 69 percent).

Kendra's Law Recipients Value The Program

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, perceptions of coercion or stigma associated with the court order and, most importantly, quality of life as a result of AOT. The interviews showed that prior to receiving court-ordered treatment, the majority of those entering the program felt anger or embarrassment. But after they received treatment, AOT recipients overwhelmingly endorsed the effect of the program on their lives:

*** 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.

Kendra's Law Improves The System's Ability To Help Those In Need

Not only is Kendra's Law helping the individuals in the program, it is also helping the system better provide treatment to all those in need. The New York Office of Mental Health detailed some of these systemic benefits in its final report: "Counties and stakeholder groups statewide have reported that the implementation of processes to provide AOT to individuals under court orders has resulted in beneficial structural changes to local mental health service delivery systems. The implementation of AOT has also supported the development of more collaborative relationships between the mental health and court systems. AOT has been instrumental in increasing accountability at all system levels regarding delivery of services to high need individuals."

The increased accountability led to a shift in the manner in which treatment to high need individuals was viewed: "Local mental health systems began to identify the potential risk posed by not responding to individuals in need, and as a result, those systems improved their ability to respond more efficiently and effectively."



1 - This statistic and all others cited in this summary, unless otherwise noted, are from the following source: N.Y. State Office of Mental Health (March 2005). Kendra's law: Final report on the status of assisted outpatient treatment. New York: Office of Mental Health.

2 - 3,908 individuals over the first 5.23 years of the program (11/8/99 - 2/1/05) = 747.7 individuals per year, or 62.3 per month. This is notably fewer people than the 10,000 people per year that Kendra's Law opponents predicted would be swept into the "dragnet" of the law.


Treatment Advocacy Center E-NEWS is a publication of the Treatment Advocacy Center.

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