Enhances the assisted outpatient treatment program and eliminates the expiration and repeal of Kendra's Law

Summary of specific provisions

Section 1 amends 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 adequately provides such training.

Section 2 provides that an educational pamphlet on AOT shall be devel- oped and distributed to family members of persons who may be in need of AOT

Section 3 clarifies that directors of community services shall be responsible for ensuring that reports of persons who may be in need of continued AOT orders are subject to a timely investigation. It also provides that directors of community services shall notify program coor- dinators when AOT patients cannot be located or are believed to have taken residence outside of the local governmental unit served.

Section 4 amends MHL § 9.48 to require that AOT program directors' quar- terly 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 amends MHL § 9.60 to clarify that assisted outpatient treat- ment services provided may include: medication education or symptom management education; appointment of a representative payee; and that tests for alcohol or drugs may be random. Also provides that the parties to the treatment order may stipulate, upon mutual consent, that an exam- ining physician need not testify in court. Also, provides that the appointed physician shall make a reasonable effort to gather relevant information for the development of a treatment plan from a member or members of the patient's family or significant other.

This section also clarifies that directors of hospitals or superinten- dents of correctional facilities may initiate a petition.

This section also provides that the Commissioner will establish a proce- dure to ensure that reports of persons who may be in need of AOT that are made by family and community members of such person are, if warranted, investigated in a timely manner, and that AOT petitions are filed, where appropriate.

This section also provides that the Commissioner shall promulgate regu- lations to require that prior to a assisted outpatient relocating to within the state of New York to a location not served by his or her current director of community services, that patient or other appropri- ate party must notify the program coordinator. The program coordinator shall then redetermine who the appropriate director shall be, and cause a copy of the court order and treatment plan to be transmitted to the new director.

This section also provides that a director shall review whether the assisted outpatient continues to meet AOT criteria within 30 days before the expiration of an order for AOT. If the director determines that such assisted outpatient no longer meets the criteria, such director is required to give notice to the program coordinator that a petition for continued AOT is unnecessary. However, if such assisted outpatient continues to meet the criteria, as determined by the director, such director shall file a petition for continued treatment.

This provision clarifies procedures any other person authorized to peti- tion for continued AOT may use to bring such petition in the event that the appropriate director or current petitioner does not petition for continued AOT prior to the expiration of the court order.

This section also provides that counties shall notify the department when an assisted outpatient is missing and thereby unavailable for an evaluation as to whether he or she continues to meet AOT criteria. It also provides that when a patient is missing upon expiration date of order, that the order shall be extended until sixty days after such patient is found.

Section 6 amends MHL §29.15: if the director of the hospital does not petition for AOT upon the discharge of an involuntarily committed inpa- tient or upon the expiration of a period of conditional release for such inpatient, such director shall report the discharge in writing to the director of community services of the local government unit where the inpatient is expected to reside.

Section 7 amends subdivision 1 of section 404 of the correction law to require that, prior to discharging an inmate who is still mentally ill, the director shall, where appropriate, either apply for a person's admission to a hospital for care and treatment, or initiate a petition for an order authorizing assisted outpatient treatment, or the commis-

sioner may apply for the person's admission to a secure treatment facil- ity.

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

Section 9 Severability.

Section 10 states that this act shall take effect immediately.

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 Office of Mental Health (OMR) research documenting declines in rates of homeless- ness, hospitalization, substance abuse, alcoholism, violence, arrest and incarceration, and documented increases in treatment compliance, service engagement and positive consumer perceptions. In 2005, the legislature opted to extend Kendra's Law for an additional five years to further 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 and in Octo- ber, 2010 Psychiatric Services published six peer reviewed studies on the AOT program. These reports confirm the earlier OMH data. These studies found patients given mandatory outpatient treatment who were more violent to begin with - were nevertheless four times less likely than members of the control group to perpetrate serious violence after undergoing assisted outpatient treatment and found less frequent psychi- atric hospitalizations, shorter length of hospitalizations, reduction in the likelihood of arrest, higher social functioning, slightly less stig- ma and no increase in perceived coercion. AOT stimulates service provid- ers efforts to prioritize care for AOT recipients; judges hearing AOT cases could benefit from additional AOT training; counties favored increasing the availability of stipulations to reduce the court burden, costs, and transportation burdens; recipients are far more likely than other patients to consistently receive psychotropic medications appro- priate to their psychiatric condition; 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 non-discriminatory manner; and that the court order itself, in addition to high quality services, is a significant factor in the program's success.

The experience of thousands of patients, treatment providers and fami- lies who have utilized Kendra's Law since 1999, point to several areas where the law should be improved to achieve costs savings, promote smoother functioning of the AOT program and easier access to those who

stand to benefit from it. The amendments included in this act are intended to reflect these findings and maximize the unique potential of this legislation to simultaneously serve the goals of compassionate care, fiscal responsibility, and public safety.

Prior legislative history

New Bill.

Fiscal implications

None.

Effective date

This act shall take effect immediately.