Fact Sheet: Myths about Kendra's Law

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Fact Sheet
Last updated October 31, 2002

MYTHS ABOUT KENDRA'S LAW

When Kendra's Law was passed, opponents had a number of concerns. Most of these are based on misinformation or misunderstanding and all have been disproved since the state began implementing the law. Have a question you don't see here? Let us know.

Kendra's Law is unconstitutional.

Kendra's Law will be used indiscriminately, affecting a huge number of New Yorkers with mental illness.

Every investigation will result in a court order.

Kendra's Law will put anyone with a history of serious mental illness at risk for commitment.

Assisted outpatient treatment does not work.

Andrew Goldstein, the man who pushed Kendra Webdale to her death, had repeatedly sought out treatment but could not get it.

General myths about assisted treatment.

MYTH Kendra's Law is unconstitutional.

REALITY Kendra’s Law in New York has been challenged twice and the courts found it to be constitutional. From Correctional Mental Health Report: "In sum, the law has thus far survived every challenge; challenges ranging from attacks on the law's essence to attacks on operational detail." (1)

From an article in the New York Law Journal: "'Kendra's Law provides the means by which society does not have to sit idly by and watch the cycle of decompensation, dangerousness and hospitalization continually repeat itself. Moreover ... Kendra's Law is narrowly tailored to achieve these goals within the framework of the involuntary and emergency commitment procedures of the Mental Hygiene Law,' Justice Cutrona wrote."

MYTH Kendra's Law will be used indiscriminately, affecting a huge number of New Yorkers with mental illness.

REALITY Kendra's Law is affecting less than 1/2 of one percent of all New Yorkers with either manic-depressive illness (bipolar disorder) or schizophrenia in any given year. According to the New York State Office of Mental Health, between its implementation and September 2002, there were 7,360 investigations, resulting in 2,216 court orders. That averages to approximately 738 orders per year during the first few years of the program.

According to the National Institutes for Mental Health (NIMH), 2.3% of Americans have either bipolar or schizophrenia. The 2000 census figure of New York's population is 18,976,457. Therefore, there are 436,459 people with either of those illnesses in New York. That means that only 738 of 436,459 people (less than 1/4 of 1 percent) per year have been placed under an initial court order.

These percentages are not for how many people are under Kendra's Law orders at a given time, but for orders initiated during a calendar year. As initial orders are for 6 months and many will not be renewed, the number of people under an order at any given time should be less - perhaps significantly less.

It is likely that this average of those affected by Kendra's Law is somewhat lower that it will be in future years, because the program was very slow to develop. However, this remains a very small percentage of the population with severe mental illnesses - the small number of people who really need AOT.

MYTH Every investigation will result in a court order.

REALITY There have been 7,360 investigations initiated for eligibility since the law took effect on Nov. 8, 1999 (463 of those were ongoing as of Sept. 3, 2002). These have resulted in 2,216 court orders. That means that in about one in three instigated investigations, the person ends up under an order. Why?

Almost half of completed investigations end with a determination that no action is needed. Of the 7,360 investigations, in 3,282 of them it was determined no further action was necessary.

Of those that result in action, about 30% are service enhancements only. 1,403 of the 4,572 investigations that were acted upon resulted in "services enhancements." This category is somewhat murky because in some counties these upgraded services include written treatment contracts (which are unenforceable, but may offer some incentive) and in others they do not. Nonetheless, all of these people are being helped to at least some extent by the law.

MYTH Kendra's Law will put anyone with a history of serious mental illness at risk for commitment.

REALITY The law has strict eligibility criteria and numerous consumer protections. A patient may be placed in assisted outpatient treatment only if, after a hearing, the court finds that ALL of the following criteria have been met. The consumer must:

be eighteen years of age or older; and

suffer from a mental illness; and

be unlikely to survive safely in the community without supervision, based on a clinical determination; and

have a history of non-compliance with treatment that has:

been a significant factor in his or her being in a hospital, prison or jail at least twice within the last thirty-six months or;
resulted in one or more acts, attempts or threats of serious violent behavior toward self or others within the last forty-eight months; and

be unlikely to voluntarily participate in treatment; and

be, in view of his or her treatment history and current behavior, in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in:

a substantial risk of physical harm to the consumer as manifested by threats of or attempts at suicide or serious bodily harm or conduct demonstrating that the consumer is dangerous to himself or herself, or
a substantial risk of physical harm to other persons as manifested by homicidal or other violent behavior by which others are placed in reasonable fear of serious physical harm; and

be likely to benefit from assisted outpatient treatment; and

if the consumer has a health care proxy, any directions in it will be taken into account by the court in determining the written treatment plan. However, nothing precludes a person with a health care proxy from being eligible for assisted outpatient treatment.

MYTH Assisted outpatient treatment does not work.

REALITY Based on preliminary findings (2) for the first 141 people in assisted outpatient treatment under Kendra's Law as of January 2001, those in the program have experienced a:

129% increase in medication compliance;

194% increase in case management use;

107% increase in housing services use;

67% increase in medication management services use;

50% increase in therapy use;

26% decrease in harmful behavior; and

100% decrease in homelessness.

Studies in North Carolina, Massachusetts, Minnesota, Hawaii, Arizona and other states also prove that assisted outpatient treatment works. Of the twelve studies to date, ten showed benefits that include reduced hospital stays, violence and arrests, and improved chances of recovery for people with severe mental illnesses. The most recent study from North Carolina, recognized as the best and most comprehensive of all the studies, demonstrated the following:

Long-term assisted outpatient treatment (LT-AOT) reduced hospital admissions by 57% and length of hospital stay by 20 days compared to individuals without court ordered treatment. The results were even more dramatic for individuals with schizophrenia and other psychotic disorders for whom LT-AOT reduced hospital admissions by 72% and length of hospital stay by 28 days compared to individuals without court ordered treatment.

A 36% reduction in violence among severely mentally ill individuals in LT-AOT (180 days or more) compared to individuals receiving less than LT-AOT (0 to 179 days). Among a group of individuals characterized as seriously violent (i.e. committed violent acts within the 4 month period prior to the study), 63.3% of those not in LT-AOT repeated violent acts while only 37.5% of those in LT-AOT did so. LT-AOT combined with routine outpatient services reduced the predicted probability of violence by 50%.

Another significant finding of the North Carolina study was that for individuals who had a history of multiple hospital admissions combined with arrest and/or violence in the prior year, LT-AOT reduced the risk of arrest by 74%. The predicted risk of being arrested for individuals with LT-AOT was 12%, compared to 47% for those who had no AOT.

MYTH Andrew Goldstein, the man who pushed Kendra Webdale to her death, had repeatedly sought out treatment but could not get it.

REALITY In 1998 alone, the State of New York and the federal government expended $95,075 for Andrew Goldstein's mental health and residential care. The New York State Commission on Quality of Care for the Mentally Disabled and the Mental Hygiene Review Board investigated and issued a report on the history of services and treatment for Andrew Goldstein (pseudonym David Dix).

The Commission reported that in the two years prior to pushing Kendra Webdale to her death in front of a New York City subway train, Goldstein received 199 days of inpatient and emergency room services, on 15 different occasions, in six different hospitals from1997 to 1999. Four different clinics provided outpatient services in this time period.

This is hardly the profile of a patient who was refused services. In fact, it was Goldstein who often refused services. He consistently stopped taking his medication after discharge from a hospital unless he was closely monitored. When he wasn't taking medication, he exhibited hallucinations, delusions, and unprovoked acts of aggression. On some occasions, when his untreated symptoms deteriorated to the point where he suffered anxiety, insomnia, or other unpleasant conditions, he went to an emergency room seeking relief. Other times, he was brought to the emergency room following a violent outburst.

For a period of approximately four years, while living in supervised residential programs, Goldstein remained medication-compliant and participated in treatment. He chose to leave the program to live on his own. Shortly after leaving, he was picked up by police after he acted aggressively in a supermarket. He returned to the supervised residence but, within months, chose to leave again. Subsequently, he refused placements offered to him in supervised residences, even though it was obvious to hospital social workers and Goldstein's mother that he needed structure, support, and medication monitoring to stay well.

Instead, the two years prior to Kendra Webdale's death were characterized by repeated emergency room visits, medication noncompliance after discharge, and at least eight incidents of unprovoked violence against others. Whenever he requested services, he either changed his mind before arrangements could be made or failed to follow through. On two occasions when he was willing to accept placement in a supervised residence, the system did not respond quickly enough before he changed his mind and opted to be discharged to his apartment instead. At no point during this time did he appear to take his medication regularly.

There is no question that the system failed Andrew Goldstein and consequently Kendra Webdale. Since New York State had no assisted treatment law at that time, there was little that could be done for someone like Mr. Goldstein who failed to stay in treatment, opted to live independently, refused services, and was medication noncomplaint. That is, until Kendra's Law was passed.

SOURCES

(1) For a full review of case law, see Fred Cohen's article in Correctional Mental Health Report, "Assisted Outpatient Treatment: Review of New York Case Law - And Beyond."

(2) New York State Office of Mental Health web site; statewide AOT report as of June 1, 2001 (viewed June 19, 2001). New York State Office of Mental Health, Progress Report on new York State's Mental Health System (Jan. 2001), pp. 16-18.

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