Enhances assisted outpatient treatment program and makes Kendra's law permanent

Summary of specific provisions

Section 1 would state the legislative findings.

Section 2 would amend Mental Hygiene Law (MHL) § 7.17(f) to require that AOT program coordinators: monitor local programs to ensure that expiring AOT orders are adequately reviewed to consider the need for renewal; and monitor local needs for training of judges and court personnel to ensure that the Office of Mental Health (OMH) adequately provides such train- ing.

Section 3 would amend MHL § 9.47(b) to clarify that a director of commu- nity services' responsibility to investigate reports of persons who may be in need of AOT applies to reports received from family and community members, as well as to written reports received from hospital directors.

Section 4 would amend MHL § 9.48 to require that AOT program directors' quarterly reports to program coordinators include information on any expired AOT court orders, including the determination made as to whether to petition for renewal, the basis for such determination, and the court's disposition of the renewal petition, if any.

Section 5 would amend MHL § 9.60 to:

* add medication or symptom management training, financial management services, and random testing for drugs or alcohol as listed potential services to be included in AOT, and clarify that other, unlisted services which may be included in an individualized treatment plan need not be clinical in nature,

* provide that the "look back" periods, used in determining whether the subject of a petition has the requisite treatment history to be eligible for AOT, are extended by the cumulative time within such periods that the subject has been hospitalized or incarcerated;

* allow the court, in determining whether the subject of an AOT petition is in need of AOT to prevent a relapse or deterioration likely to result in serious harm, to consider not only the subject's "current" behavior, but past behavior as well;

* Require OMH to make qualified physicians available to counties with populations under 75,000, for the purposes of assisting with AOT petitions;

* Allow the subject of an AOT petition and the petitioner to stipulate upon mutual consent that a physician need not testify at the AOT hear- ing;

* Clarify that in determining whether a subject of an AOT petition who has refused to submit to an examination should be removed to a hospital for such purpose, the court need not hold a hearing;

* Require a physician appointed to develop a treatment plan for the subject of an AOT petition to make reasonable efforts to gather poten- tially relevant information from the subject's family or significant others;

* Increase the maximum potential length of an initial AOT court order from six months to one year;

* Require that if during the period of an AOT order, the assisted outpa- tient relocates to a location within New York not served by the current- ly obligated AOT program, such obligation to provide AOT shall transfer to the director of community services of the local governmental unit to which the assisted outpatient has relocated;

* Require an AOT program director, upon determining not to petition for renewal of an expiring AOT order, to notify the appropriate program coordinator in writing, stating the basis for the determination;

* Provide that if an AOT order is allowed to expire and a new AOT peti- tion is filed within 60 days by another authorized petitioner, the new petitioner (mirroring existing law for a renewal by the current peti- tioner) need not establish anew that the subject of the petition has experienced either two hospitalizations within the last 36 months or one violent incident within the last 48 months;

* Require that if an AOT order is appealed, notice be provided to multi- ple parties including the appropriate director of community services and the appropriate program coordinator;

* Establish a presumption that an assisted outpatient should be removed to a hospital to determine his or her need for admission if, despite efforts to solicit compliance, he or she has violated the order of the court by substantially failing to take medication, submit to blood test- ing or urinalysis, or comply with drug or alcohol treatment;

* Require OMH to provide AOT training to judges and court personnel with such frequency and in such locations as may be appropriate to meet statewide needs.

Section 6 would add a new paragraph (o) to MHL § 29.15 to require the director of a hospital who does not petition for AOT upon the discharge of an involuntary inpatient, or upon the expiration of a conditional release of such inpatient, to report such discharge or expiration in writing to the appropriate director of community services. (Under Section 3 of the bill, the director of community services would then be required to investigate whether the inpatient meets the criteria for AOT.)

Section 7 would amend Correction Law § 404(2) to require the director of a hospital serving mentally ill prison inmates, upon discharging such an inmate to the community at the expiration of his or her prison sentence, to report such discharge in writing to the appropriate director of community services, stating a recommendation as to whether the inmate meets the criteria for AOT, and the basis for such recommendation. (Under Section 3 of the bill, the director of community services would then be required to investigate whether the inmate meets the criteria for AOT.)

Section 8 would repeal the current sunset date to extend the provisions of Kendra's Law indefinitely.

Section 9 would provide a separability clause.

Section 10 would provide an effective date of June 30, 2010; provided that if the act does not become law on or before June 30, 2010, the provisions would take effect immediately and be deemed to be in full force and effect on and after June 30, 2010.

Effect on current law

The current provisions of Kendra's Law are set to expire on June 30, 2010. This bill would remove the expiration date and extend Kendra's Law indefinitely. It would also amend the current law to require greater accountability from those responsible for its implementation, to more effectively allow families and caregivers to be appropriately engaged in the AOT process, and to improve the coordination and delivery of services to assisted outpatients.

Justification

In 1999, the legislature enacted "Kendra's Law," establishing a state- wide court-ordered assisted outpatient treatment (AOT) program to improve outcomes for persons with severe mental illness who, in view of their treatment history and present circumstances, are likely to have difficulty living safely in the community. At the approach of the law's original 2005 expiration date, the legislature took note of OMH data indicating that Kendra's Law had impressively served its targeted popu-

lation, including documented declines in rates of homelessness, hospi- talization, violence, arrest and incarceration, and documented increases in treatment compliance. However, at that time questions and concerns about the program remained unanswered. Rather than make the law perma- nent in 2005, the legislature opted to extend Kendra's Law for an addi- tional five years with a mandate that OMH contract with an external research organization to evaluate the program.

On June 30, 2009, a team of independent researchers released the report of their long-term study of AOT throughout New York State. This report confirms the earlier OMH data on vastly improved outcomes, including less frequent psychiatric hospitalizations, shorter length of hospitali- zations, and reduction in the likelihood of arrest. It further estab- lishes, inter alia, that AOT recipients are1far more likely than other patients to consistently receive psychotropic medications appropriate to their psychiatric condition; that AOT does not cause recipients to perceive stigma or coercion; that those who receive AOT for periods of at least one year are more likely than those who receive AOT for shorter periods to sustain gains after leaving the program; that the law has been applied in a nondiscriminatory manner; and that the court order itself, in addition to high quality services, is a significant factor in the program's success.

Based on these empirical findings, the concerns/which led the legisla- ture to extend the expiration of Kendra's Law in 2005 have been addressed. Kendra's Law should be made a permanent fixture of New York's mental health care system.

Moreover, the June 30, 2009 study findings, as well as the experience of thousands of patients, treatment providers and families who have utilized Kendra's Law since 1999, point to several areas where the law should be improved to promote smoother functioning of the AOT program and easier access to those who stand to benefit from it. The amendments included in this bill are intended to reflect these findings and maxi- mize the unique potential of this legislation to simultaneously serve the goals of compassionate care, fiscal responsibility, and public safe- ty.

Prior legislative history

This is a new bill.

Fiscal implications

Minimal.

Effective date

June 30, 2010