A court-ordered treatment option that has been opposed by some mental
health advocates as dangerous for both patients and clinicians in fact
provides effective assistance to people with serious mental illness,
researchers have concluded.
Their conclusions were based on a study of the effects of New York's 1999
Kendra's Law, which allows court-ordered assisted outpatient treatment (AOT)
for people with severe mental illness who have been repeatedly arrested.
Recipients generally were found to fare better during and after AOT if the AOT
order lasted for six months or more. Once recipients left the program, those
who continued to receive intensive treatment services or received longer
periods of AOT were more likely to sustain
"The clear fact is that Kendra's Law is an effective mechanism to
engage people with the most severe forms of mental illness in outpatient
treatment," said Rosanna Esposito, interim acting executive director of
the Treatment Advocacy Center, a Virginia-based nonprofit organization.
Kendra's Law, Esposito said in a written statement, is "working just
as intended" by reducing hospitalizations, arrests, substance abuse, and
other negative consequences of mental illness, while greatly increasing
The New York law is named for Kendra Webdale, a 32-year-old woman who in
January 1999 was pushed into the path of a subway train by a man with
untreated schizophrenia. Seven months after her death, Kendra's Law was
enacted to provide court-ordered AOT for people with serious mental illness
who, due to a history of noncompliance with treatment, cycle in and out of
hospitals, jails, prisons, and homeless shelters (Psychiatric News,
August 19, 2005).
To be eligible for AOT, the person's noncompliance must have resulted in
either two psychiatric hospitalizations or treatment in a correctional
facility in the prior three years or at least one threat or act of violence
toward self or others in the prior four years.
The researchers, led by Marvin Swartz, M.D., of the Department of
Psychiatry at Duke University School of Medicine, concluded that the
recipients improved on a range of outcomes. The researchers did not find
evidence of feared negative consequences.
Among the findings was evidence that court-ordered AOT recipients are at
lower risk of arrest than their counterparts participating in enhanced
voluntary services. The risk of hospitalization among recipients of AOT when
combined with assertive community treatment (ACT) services (a specific type of
case management sometimes used under AOT) was substantially lower, compared
with receiving ACT outside of the program.
The outpatient involuntary commitment approach has drawn strong opposition
from some mental health advocates. Those who oppose involuntary treatment said
it would have a negative effect on the mindset of both the patient and the
clinician who conducts it. The court-ordered treatment approach, they said,
would interfere with the patient's self-definition and self-esteem and place
the clinician in an authoritarian role, since he or she would be providing
treatment that a court had ordered.
The researchers' findings did not bear out those concerns."
Perceptions of the AOT program, experiences of stigma, coercion, and
treatment satisfaction appear to be largely unaffected by participation in the
program and are likely more strongly shaped by other experiences with mental
illness and treatment," wrote Swartz and colleagues.
Among the negative findings regarding the use of AOT in New York was that
the approach appeared to reduce access to services for non-AOT recipients in
the period shortly after Kendra's Law was enacted. However, in recent years
the number of new AOT cases has dropped, as has the redirection of services
from non-AOT to AOT patients.
However, like many other state-funded aspects of mental health care, the
recession and the lack of new funding for the New York program "will
likely increase competition for access to services once again," the
"New York State Assisted Outpatient Treatment Program
Evaluation" is posted at<www.macarthur.virginia.edu/aot_finalreport.pdf>.▪