NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1275
SPONSOR: Gunther (MS) TITLE OF BILL: An act to amend the mental hygiene law and the
correction law, in relation to enhancing the assisted outpatient treat-
ment program; and to amend Kendra's Law, in relation to making the
provisions thereof permanent
PURPOSE OR GENERAL IDEA OF BILL: To improve care for people with seri-
ous 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.
Section 3 amends § 9.47(b) 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' 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 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 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.
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 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 superinten-
dents of correctional facilities may initiate a petition.
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 if thirty days prior to the expiration of an order,
the assisted outpatient is deemed by the appropriate direct to be miss-
ing and thereby unavailable for evaluation, such director shall petition
the court to extend the term of the current order until sixty days after
such time as the assisted outpatient out is located.
Section 6 amends MHL § 29.15 to provide that if the director of a.
department facility 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 3 of section 404 of the correction law to
require that, prior to discharging an inmate committed from a hospital
in the department of mental hygiene to the community, the director shall
ensure that a clinical assessment has been completed to determine wheth-
er the inmate meets the criteria for AOT. This section also provides
that if, as a result of such assessment, the director determines that
the inmate meets such criteria, prior to the discharge the director of
the hospital shall either petition for a court order or report in writ-
ing to the director of community services of the local governmental unit
in which the inmate is expected to reside so that an investigation may
be conducted.
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," estab-
lishing 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 compli-
ance, 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 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, loop-
holes 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 compassion-
ate care, fiscal responsibility, and public safety.
PRIOR LEGISLATIVE HISTORY: 2013-2014: A.1544A Referred to Mental
Health 2011-2012: A.6987B/S.4881B Referred to Mental Health
FISCAL IMPLICATIONS: None.
EFFECTIVE DATE: This act shall take effect immediately.
