Time to Strengthen Kendras Law
A new bill would improve care for the mentally ill.
In 1999, journalist Kendra Webdale became the latest person pushed to her death under a subway train by a man with schizophrenia whom New York States Office of Mental Health (OMH) had allowed to go untreated. In response, state legislators finally passed a law that let courts order seriously mentally ill people with a past history of violence and who pose a threat of future violence to enter outpatient treatment. They named it Kendras Law, and it has been a huge success. In 2005, the OMH found that after entering court-ordered outpatient treatment, people covered by the law were far less likely to harm themselves or others, damage property, or abuse alcohol or drugs. The law also saved money by dramatically reducing psychiatric hospitalizations, arrests, and incarcerations.
Despite these findings, the OMH has always undermined Kendras Law. The agency opposed its passage in 1999, and current OMH commissioner Michael Hogan argues that the law is stigmatizing to the mentally ill and that, despite research to the contrary, treatments that are theoretically the best but not accepted by an individual are unlikely to be effective. When the legislature allocated the OMH $125 million to implement Kendras Law in 2000, the agency diverted a portion of those funds to people who agreed to stay in treatment without a court orderthat is, people who by definition werent covered by the law.
The OMHs refusal to fund enough Kendras Law case managers forces the existing managers to struggle under far too many caseloads. As a consequence, when hospital or prison officials contact the OMH about a patient or an inmate who might need to be ordered into treatment, they are frequently discouraged by the agencys long delays and simply discharge their wards without any requirement to stay in treatment.
In addition, the OMH generously funds the New York Association of Psychiatric Rehabilitation Services (NYAPRS), a trade association whose main function seems to be to prevent the treatment of people with serious mental illness under Kendras Law. NYAPRS has argued, both in press releases and in testimony to the state legislature, that the law is unconstitutional and violates civil liberties; courts have nevertheless found it an appropriate use of the states police and parens patriae powers. In 2005, NYAPRS tried a new tack, alleging that Kendras Law was racially biased. Responding to this claim, the state legislature had the OMH fund an independent study by Duke University. The studys conclusion: We find no evidence that [Kendras Law] is disproportionately selecting African Americans for court orders, nor is there evidence of a disproportionate effect on other minority populations.
The result of the OMHs obstructionism is that only 1,900 individualsfewer than one-fifth the number that the agency originally predictedare covered by Kendras Law. Another 7,000 had their court orders expire without an OMH review of whether that was safe for them and for the public. The OMH continues allowing the release of mentally ill patients and prisoners who have a history of being dangerous without first evaluating whether they need court-ordered treatment to prevent them from becoming violent again.
Fortunately, a legislative remedy is at hand: the Kendras Law Care Improvement Act, recently introduced by state assemblywoman Aileen Gunther, a registered nurse who has worked in a psychiatric unit. Among other things, the bill would close the loophole through which people who were hospitalized because they were a danger to self or others, as well as those who received mental-illness services while imprisoned, can be released without anyones determining whether a court order to undergo outpatient treatment is necessary. A diverse group of organizations, including the Alliance on Mental Illness of New York State, the Harlem Alliance for the Mentally Ill, the New York State Chiefs of Police, and the District Attorneys Association of the State of New York, backs Gunthers bill. Governor Cuomo should get behind the bill, too. Failure to pass it would be inhumane to a suffering population and potentially dangerous to the public.
D. J. Jaffe, a longtime advocate for the mentally ill, is the founder of Mental Illness Policy Org.