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 of the order; to ensure appropriate assignment of a director for each outpatient; and to monitor local needs for training of judges and court personnel in order for the office of mental health to adequately provide such training.

Section 2 provides that the Commissioner of Mental Health shall develop an educational pamphlet on the process of petitioning for AOT to be made available to persons wishing to submit reports of individuals who may be in need of AOT, as well as disseminated to family members and other individuals eligible to petition for AOT.

Section 3 amends § 9.47 of the MHL to clarify 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 coordinators 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' quarterly reports to program coordinators include information on any expired AOT court orders, including the determination made as to whether to petition for renewal of the AOT, 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 treatment 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. This section also provides that the parties to the treatment order may stipulate, upon mutual consent, that an examining physician need not testify in court. The bill 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 superintendents of correctional facilities may initiate a petition.

This section also requires the Commissioner to establish by regulation a procedure 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 regulations to require that prior to an assisted outpatient relocating to a location within the state of New York which is not served by his or her current director of community services, that patient or other appropriate 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 petition 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 the expiration date of the order, the order shall be extended until sixty days after such patient is found.

Section 6 amends MHL § 29.15 to provide that if the director of the hospital does not petition for AOT upon the discharge of an involuntarily committed inpatient 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 commissioner may apply for the person's admission to a secure treatment facility.

Subdivision(3)of Section 404 of the corrections law is amended to require that a director of community services of the local government unit where the inmate will reside who has received a written report from a director of a hospital that has completed an AOT clinical assessment for an inmate being discharged from a hospital in the

department of mental hygiene shall conduct an investigation pursuant to section 9.47 of the mental hygiene law.

A new subdivision (4) of section 404 of the correction law is also added to require that within a reasonable period before release or discharge of an inmate with a serious mental illness pursuant to paragraph (e) of subdivision 6 of section 137 of the correction law, the department shall notify the director of a hospital who shall ensure that a clinical assessment has been completed to determine if the inmate meets the criteria for AOT treatment pursuant to Mental Hygiene law section 9.60. If the inmate is determined to meet such criteria the hospital director shall either petition the court for an order pursuant to section 9.60 of the mental hygiene law, or report in writing to the director of community services of the local government unit in which the inmate resides so that an investigation will be conducted pursuant to section 9.47 of the mental hygiene law.

Section 8 would repeal the current sunset date of June 30, 2017 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 statewide 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 the Office of Mental Health (OMH) research documenting declines in rates of homelessness, hospitalization, substance abuse, alcoholism, violence, arrest and incarceration, and documented increases in treatment compliance, service engagement and positive consumer perceptions. In 2005 and 2010, the legislature opted to extend Kendra's Law for an additional five years to further evaluate the program. The New York SAFE Act, which was signed into law on January 15, 2013, also extended Kendra's Law for an additional two years, making the law expire on June 30, 2017.

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 October, 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. The studies also found less frequent psychiatric hospitalizations, shorter length of hospitalizations, reduction in the likelihood of arrest, higher social functioning, slightly less stigma and no increase in perceived coercion. These studies confirmed that AOT stimulates service provider's 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 appropriate 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 families 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. Although the New York SAFE Act addresses many of these concerns, loopholes still exist in the law. The amendments included in this act are intended to close these loopholes and maximize the unique potential of this legislation, while simultaneously serving the goals of compassionate care, fiscal responsibility, and public safety.

Prior legislative history

2014:S.2225D Passed Senate 2013:S.2225B Referred to Mental Health/Developmental Disabilities 2011,2012: S.4881B Referred to Mental Health/Developmental Disabilities

Fiscal implications

To be determined. Cost-savings for the state and local governments are anticipated following implementation, due to reduced instances of hospitalizations and incarcerations that would result.

Effective date

This act shall take effect immediately.