REPORT SHOWS SUCCESS OF NEW YORK'S KENDRA'S LAW

Sharp reductions in hospitalizations, incarcerations, homelessness,
for people with severe mental illnesses

ARLINGTON, VA – Kendra's Law, New York's 5-year-old program allowing court-ordered community treatment for someone with a severe mental illness, is a remarkable success. New statistics show that during assisted outpatient treatment (AOT), 74% fewer participants experienced homelessness, 77% fewer experienced psychiatric hospitalization, 83% fewer experienced arrest, and 87% fewer experienced incarceration. Individuals in Kendra's Law were also more likely to regularly participate in services and take prescribed medication.

Without action by the state legislature, Kendra's Law will sunset June 30, 2005. Gov. George Pataki has released a bill to make Kendra's Law permanent, noting "The results are clear, Kendra's Law works."

"Thanks to Governor Pataki's leadership, AOT resulted in fundamental changes to New York's overall mental health system," said Sharon Carpinello, R.N., Ph.D., Commissioner of the New York State Office of Mental Health, whose office released the 5-year report on the program's successes. "We have seen improved access to mental health services, improved coordination of service planning, enhanced accountability, and improved collaboration between the mental health and court systems. But when summarizign the results of AOT, it is most important to note the positive impact the program is having on the people who have successfully used it. Individuals with mental illness who participate in AOT are able to make and maintain real gains in their recovery - the data tells us that, and so do the recipients."

"We knew that Kendra's Law would save lives," said Pat Webdale, mother of Kendra Webdale, for whom New York's law was named. "But we are amazed to see how dramatic those numbers really are. When Kendra was killed by a man with a long history fo untreated schizophrenia, the grief we felt was unspeakable. In the course of advocating for a law that would prevent similar tragedies, we learned that assisted outpatient treatment can save both the lives of people like my daughter and the lives of those imprisoned by brain diseases. It is gratifying to see the big difference Kendra's Law is making."

With only about 747 participants each year, AOT primarily helps those who are the most ill. A full 97% of participants had at least one psychiatric hospitalization in the 3 years before they received a court order. When compared with a similar population of mental health service recipients, those placed in AOT were twice as likely to have been homeless, 50% more likely to have had contact with the criminal justice system, and 58% more likely to have a co-occurring mental illness and substance abuse condition.

"Without AOT, my son would either be in jail or dead," said "Susan" from New York City. "It alone has made a difference for him by helping him to stay on his meds."

According to NAMI New York, who interviewed family members like Susan about Kendra's Law, most mental health providers are taking Kendra's Law seriously and often give those who are on AOT priority in receiving services.

"We were very dubious of Kendra's Law at the beginning," said Dr. Mary Barber, associate medical director of the Ulster County Mental Health Department. "We feel differently now. As I've heard many people say, Kendra's Law is so effective in part because it makes providers accountable, by both allowing and requiring communication, and by making them feel more secure in taking very risky clients. Kendra's Law essentially said that counties now have responsibility over their most high-risk, high-need people. With that responsibility comes the opportunity to exert more centralized control over housing, treatment, and case management resources."

"The enhanced communication with other regions is also a big improvement with AOT," said Dr. Barber. "We've always had patients who move here from the city or other counties in the region, but typically we would not hear about them until they showed up in jail or the hospital. Now we get advance notice for people on petitions and we can be more proactive. People don't get lost for months and show up in extreme crisis."

"New York's mental health advocates are to be commended for their continued efforts to see that Kendra's Law is used effectively," said Treatment Advocacy Center Executive Director Mary T. Zdanowicz. The Treatment Advocacy Center is a national nonprofit dedicated to removing barriers to treatment of severe mental illnesses. "It is important to support and promote proven programs like AOT. New York's continuing work to update and improve its broader mental health system can only be buoyed by the good news that this existing program is improving not only lives, but the system itself."

Among the report's major findings:

• AOT reduced hospitalization days. On average, AOT recipients' length of hospitalization was reduced 56% from pre-AOT levels. Even after termination of the court order, that decline continued - during the first 6 months following the end of the order, total days were reduced 73% from the pre-AOT total.
• Kendra's Law reduced behaviors. 55% fewer recipients engaged in suicide attempts or physical harm to self, 49% fewer abused alcohol, 48% fewer abused drugs, 47% fewer physically harmed others, 46% fewer damaged or destroyed property, and 43% fewer threatened physical harm to others. Overall, the average decrease in harmful behaviors was 44%.
• AOT improved treatment compliance. The number of individuals exhibiting good adherence to medication increased by 51% and the number of individuals exhibiting good service engagement increased by 103%.
• AOT had a positive effect on the therapeutic alliance. 87% of participants interviewed said they were confident in their case manager's ability to help them - and 88% said they and their case manager agreed on what is important for them to work on.
• AOT recipients endorsed the effect of the program on their lives. After receiving treatment, 75% reported that AOT helped them gain control over their lives, 81% said AOT helped them get and stay well, and 90% said AOT made them more likely to keep appointments and take medication. This despite the fact that about half of interviewed recipients initially felt angry or embarrassed about the court order.

Forty-two states have AOT laws. OMH's report is available at http://www.omh.state.ny.us/omhweb/Kendra_web/finalreport/.

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