What's happening
This bill makes Kendra's Law, which governs assisted outpatient mental health treatment in New York, permanent and expands its processes and oversight.
Why it matters
Strengthens oversight and accountability. The bill requires more rigorous monitoring of assisted outpatient treatment (AOT) programs, including new mandates for program coordinators and directors to track treatment compliance, investigate reports of individuals in need, and report outcomes. This could lead to more consistent application of AOT and improved outcomes for individuals under court-ordered mental health care.
Expands eligibility and referral pathways. The legislation broadens who can initiate petitions for AOT orders—including physicians, nurse practitioners, and directors of homeless shelters—and clarifies procedures for transitioning individuals between counties or jurisdictions. This may make it easier for at-risk individuals to be identified and engaged in treatment, potentially reducing hospitalizations, incarceration, or harm.
Improves transparency and public understanding. The bill requires the creation and distribution of plain-language educational materials explaining AOT criteria, processes, and rights, and calls for expanded training for judges and court staff. This could empower families and the public to better navigate the system and safeguard the rights of those subject to AOT.
Enhances follow-up after hospitalization or incarceration. The bill mandates clinical assessments for individuals with serious mental illness prior to discharge from hospitals or correctional facilities to determine AOT eligibility, with required notification and follow-up by local services. This aims to ensure continuity of care and reduce the risk of relapse or adverse events following release into the community.
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Who cares
Headline styles
Make Kendra's Law Permanent
Plain English, a few words. Used as the page title.
Sponsors
History
- Recommit, enacting clause stricken
- Referred to mental health and developmental disabilities
Full text
14 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
919
2019-2020 Regular Sessions
IN SENATE
January 9, 2019
Introduced by Sens. YOUNG, ADDABBO, AKSHAR, AMEDORE, BOYLE, FELDER, FUNKE, GALLIVAN, GRIFFO, HELMING, LANZA, LITTLE, O'MARA, RANZENHOFER, RITCHIE, ROBACH, SERINO, SEWARD, STAVISKY -- read twice and ordered printed, and when printed to be committed to the Committee on Mental Health and Developmental Disabilities
AN ACT to amend the mental hygiene law and the correction law, in relation to enhancing the assisted outpatient treatment program; and to amend Kendra's Law, in relation to making the provisions thereof permanent
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 2 of subdivision (f) of section 7.17 of the mental hygiene law, as amended by chapter 158 of the laws of 2005, is amended to read as follows:
(2) The oversight and monitoring role of the program coordinator of the assisted outpatient treatment program shall include each of the following:
(i) that each assisted outpatient receives the treatment provided for in the court order issued pursuant to section 9.60 of this [chapter] title;
(ii) that existing services located in the assisted outpatient's community are utilized whenever practicable;
(iii) that a case manager or assertive community treatment team is designated for each assisted outpatient;
(iv) that a mechanism exists for such case manager, or assertive community treatment team, to regularly report the assisted outpatient's compliance, or lack of compliance with treatment, to the director of the assisted outpatient treatment program;
(v) that directors of community services establish procedures [which] that provide that reports of persons who may be in need of assisted
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01829-02-9
S. 919 2
outpatient treatment are appropriately investigated in a timely manner; [and]
(vi) that assisted outpatient treatment services are delivered in a timely manner[.];
(vii) that, prior to the expiration of assisted outpatient treatment orders, the clinical needs of assisted outpatients are adequately reviewed in determining the need to petition for continued assisted outpatient treatment pursuant to subdivision (m) of section 9.60 of this title;
(viii) that the appropriate director is determined for each assisted outpatient, pursuant to subdivisions (k) and (l) of section 9.60 of this title; and
(ix) that the office fulfills its duties pursuant to subdivision (t) of section 9.60 of this title to meet local needs for training of judges and court personnel.
§ 2. Subdivision (f) of section 7.17 of the mental hygiene law is amended by adding a new paragraph 5 to read as follows:
(5) The commissioner shall develop an educational pamphlet on the process of petitioning for assisted outpatient treatment for dissemination to individuals seeking to submit reports of persons who may be in need of assisted outpatient treatment, and individuals seeking to file a petition pursuant to subparagraph (i) or (ii) of paragraph one of subdivision (f) of section 9.60 of this title. Such pamphlet shall set forth, in plain language: the criteria for assisted outpatient treatment, resources available to such individuals, the responsibilities of program coordinators and directors of community services, a summary of current law, the process for petitioning for continued assisted outpatient treatment, and other such information the commissioner determines to be pertinent.
§ 3. Subdivision (b) of section 9.47 of the mental hygiene law, as amended by chapter 158 of the laws of 2005, paragraphs 5 and 6 as added and paragraph 7 as renumbered by chapter 1 of the laws of 2013, is amended to read as follows:
(b) All directors of community services shall be responsible for:
(1) receiving reports of persons who may be in need of assisted outpatient treatment pursuant to section 9.60 of this article and documenting the receipt date of such reports;
(2) conducting timely investigations of such reports received pursuant to paragraph one of this subdivision and providing written notice upon the completion of investigations to reporting persons and program coordinators, appointed by the commissioner [of mental health] pursuant to subdivision (f) of section 7.17 of this title, and documenting the initiation and completion dates of such investigations and the dispositions;
(3) filing of petitions for assisted outpatient treatment pursuant to [paragraph] subparagraph (vii) of paragraph one of subdivision [(e)] (f) of section 9.60 of this article, and documenting the petition filing [date] dates and the [date] dates of the court [order] orders;
(4) coordinating the timely delivery of court ordered services with program coordinators and documenting the date assisted outpatients begin to receive the services mandated in the court order; [and]
(5) ensuring evaluation of the need for ongoing assisted outpatient treatment pursuant to subdivision [(k)] (m) of section 9.60 of this article prior to the expiration of any assisted outpatient treatment order;
S. 919 3
(6) if he or she has been ordered to provide for or arrange for assisted outpatient treatment pursuant to paragraph five of subdivision [(j)] (k) of section 9.60 of this article or became the appropriate director pursuant to this paragraph or subdivision (c) of section 9.48 of this article, notifying the director of community services of the new county of residence when he or she has reason to believe that an assisted outpatient has or will change his or her county of residence during the pendency of an assisted outpatient treatment order. Upon such change of residence, the director of the new county of residence shall become the appropriate director, as such term is defined in section 9.60 of this article; [and]
(7) notifying program coordinators when assisted outpatients cannot be located after reasonable efforts or are believed to have taken residence outside of the local governmental unit served; and
(8) reporting on a quarterly basis to program coordinators the information collected pursuant to this subdivision.
§ 4. Paragraphs (viii) and (ix) of subdivision (b) of section 9.48 of the mental hygiene law are renumbered paragraphs (ix) and (x) and a new paragraph (viii) is added to read as follows:
(viii) an account of any court order expiration, including but not limited to the director's determination as to whether to petition for continued assisted outpatient treatment, pursuant to section 9.60 of this article, the basis for such determination, and the disposition of any such petition;
§ 5. Section 9.60 of the mental hygiene law, as amended by chapter 158 of the laws of 2005, paragraph 1 of subdivision (a) as amended by section 1 of part E of chapter 111 of the laws of 2010, paragraph 3 of subdivision (a), paragraphs 2 and 5 of subdivision (j), and subdivisions (k) and (n) as amended by chapter 1 of the laws of 2013, paragraph 5 of subdivision (c) as amended by chapter 137 of the laws of 2005 and paragraph 4 of subdivision (e) as amended by chapter 382 of the laws of 2015, is amended to read as follows: § 9.60 Assisted outpatient treatment.
(a) Definitions. For purposes of this section, the following definitions shall apply:
(1) "assisted outpatient treatment" shall mean categories of outpatient services [which] that have been ordered by the court pursuant to this section. Such treatment shall include case management services or assertive community treatment team services to provide care coordination, and may also include any of the following categories of services: medication support; medication education or symptom management education; periodic blood tests or urinalysis to determine compliance with prescribed medications; individual or group therapy; day or partial day programming activities; educational and vocational training or activities; appointment of a representative payee or other financial management services, subject to final approval of the Social Security Administration, where applicable; alcohol or substance abuse treatment and counseling and periodic or random tests for the presence of alcohol or illegal drugs for persons with a history of alcohol or substance abuse; supervision of living arrangements; and any other services within a local services plan developed pursuant to article forty-one of this chapter, clinical or non-clinical, prescribed to treat the person's mental illness and to assist the person in living and functioning in the community, or to attempt to prevent a relapse or deterioration that may reasonably be predicted to result in attempted suicide, serious physical harm to any person or the need for hospitalization.
S. 919 4
(2) "director" shall mean the director of community services of a local governmental unit, or the director of a hospital licensed or operated by the office of mental health which operates, directs and supervises an assisted outpatient treatment program.
(3) "director of community services" and "local governmental unit" shall have the same meanings as provided in article forty-one of this chapter. The "appropriate director" shall mean the director of community services of the county where the assisted outpatient resides, even if it is a different county than the county where the assisted outpatient treatment order was originally issued.
(4) "assisted outpatient treatment program" shall mean a system to arrange for and coordinate the provision of assisted outpatient treatment, to monitor treatment compliance by assisted outpatients, to evaluate the condition or needs of assisted outpatients, to take appropriate steps to address the needs of such individuals, and to ensure compliance with court orders.
(5) "assisted outpatient" shall mean the person under a court order to receive assisted outpatient treatment.
(6) "subject of the petition" or "subject" shall mean the person who is alleged in a petition, filed pursuant to the provisions of this section, to meet the criteria for assisted outpatient treatment.
(7) "correctional facility" and "local correctional facility" shall have the same meanings as provided in section two of the correction law.
(8) "health care proxy" and "health care agent" shall have the same meanings as provided in article twenty-nine-C of the public health law.
(9) "program coordinator" shall mean an individual appointed by the commissioner [of mental health], pursuant to subdivision (f) of section 7.17 of this chapter, who is responsible for the oversight and monitoring of assisted outpatient treatment programs.
(b) Programs. The director of community services of each local governmental unit shall operate, direct and supervise an assisted outpatient treatment program. The director of a hospital licensed or operated by the office [of mental health] may operate, direct and supervise an assisted outpatient treatment program, upon approval by the commissioner. Directors of community services shall be permitted to satisfy the provisions of this subdivision through the operation of joint assisted outpatient treatment programs. Nothing in this subdivision shall be interpreted to preclude the combination or coordination of efforts between and among local governmental units and hospitals in providing and coordinating assisted outpatient treatment.
(c) Criteria. A person may be ordered to receive assisted outpatient treatment if the court finds that such person:
(1) is eighteen years of age or older; and
(2) is suffering from a mental illness; and
(3) is unlikely to survive safely in the community without supervision, based on a clinical determination; and
(4) has a history of lack of compliance with treatment for mental illness that has:
(i) [prior to the filing of the petition,] at least twice within the [last] thirty-six months prior to the filing of the petition been a significant factor in necessitating hospitalization in a hospital, or receipt of services in a forensic or other mental health unit of a correctional facility or a local correctional facility[, not including]; provided that such thirty-six month period shall be extended by the length of any current period[, or period ending] of hospitalization or incarceration, and any such period that ended within the last six
S. 919 5
months[, during which the person was or is hospitalized or incarcerated]; or
(ii) within forty-eight months prior to the filing of the petition, resulted in one or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others [within the last forty-eight months, not including]; provided that such forty-eight month period shall be extended by the length of any current period[, or period ending] of hospitalization or incarceration, and any such period that ended within the last six months[, in which the person was or is hospitalized or incarcerated]; and
(5) is, as a result of his or her mental illness, unlikely to voluntarily participate in outpatient treatment that would enable him or her to live safely in the community; and
(6) in view of his or her treatment history and current behavior, is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in serious harm to the person or others as defined in section 9.01 of this article; and
(7) is likely to benefit from assisted outpatient treatment.
(d) Health care proxy. Nothing in this section shall preclude a person with a health care proxy from being subject to a petition pursuant to this chapter and consistent with article twenty-nine-C of the public health law.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Purpose or general idea of bill
To improve care for people with serious mental illness, and protect the safety of patients and the public by streamlining and improving New York's Assisted Outpatient Treatment (AOT) program (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 outpa- tient; 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.
Read the full memo (1,765 words)
Section 3 amends § 9.47 of the MHL to clarify that directors of communi- ty 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' quar- terly reports to program coordinators include information on any expired assisted outpatient treatment court orders, including the determination made as to whether to petition for renewal of the assisted outpatient treatment, the basis for such determination, and the court's disposition of the renewal petition, if any.
Section 5 amends MHL § 9.60 to add the prevention of attempted suicide and serious physical harm to any person to the qualifying conditions for which AOT may be applicable. It also clarifies 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 clarifies that directors of hospitals or superintendents of correctional facilities may initiate a petition.
The bill also provides that a licensed physician or a nurse practitioner who is treating the patient, or the director of a homeless shelter may institute am AOT 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 regu- lations 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 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 the expiration date of the order, the order shall be extended until sixty days after such patient is found.
Section 6 amends MiiL § 29.15 to provide that if the director of the hospital does not petition for AOT upon the discharge of an involuntar- ily committed inpatient or upon the expiration of a period of condi- tional 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.
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 assessmentò 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 (5) 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 communi- ty 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, 2022 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 the Office of Mental Health (0MH).research documenting declines in rates of home- lessness, 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. Kendra's Law was subsequently extended an additional five years and will expire on June 30, 2022.
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. The studies also found less frequent psychiatric hospitalizations, shorter length of hospitaliza- tions, 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 bene- fit from additional AOT training; counties favored increasing the avail- ability of stipulations to reduce the court burden, costs, and transpor- tation 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 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. 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 safe- ty.
Prior legislative history
2018:S.516-B Passed Senate
2017: S.516/A.604 Passed Senate
2015,2016: S.4722/A.1275 Passed Senate
2014: S.2225D Passed Senate
2013: S.2225B Referred to Mental Health & Developmental Disabilities
2011,2012: S.4881B/A.6987-B 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 hospi- talizations and incarcerations that would result.
Effective date
This act shall take effect immediately.
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