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Briefing Paper
March 30, 2005
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ASSISTED OUTPATIENT TREATMENT:
RESULTS FROM NEW YORK'S KENDRA'S LAW
| READ THE REPORT: 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. READ TAC's PRESS RELEASE |
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.1 An average of 62 individuals
per month, or 747 individuals per year, were ordered to maintain treatment under the
program.2 That is approximately 39 per year per million people
in the state population.3
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
During the course of court-ordered treatment4,
when 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. The
majority received case management, medication management, and/or individual or group
therapy prior to AOT. 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.
Overall, the average decrease in harmful behavior was 44
percent.
Kendra’s Law improves treatment
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 103 percent (from only 34
percent to 69 percent).
The number of
individuals exhibiting good service engagement increased by 51 percent (from 41 percent to
62 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. While the interviews showed that the
experience of being court-ordered into treatment made about half of recipients feel
angry or embarrassed, 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. AOT had a positive effect on the therapeutic alliance.
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.”
ENDNOTES
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.
3 New
York’s population is approximately 19 million. See
http://quickfacts.census.gov/qfd/states/36000.html.
4 The average timeframe for court orders
was 16 months, and ranged from six months to more than 30 months.
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