After payment by Hochul and Adams, court-ordered mental health treatment increase

Announcement by Governor Hochhol and Mayor Adams (Photo: Ed Reed/Mayor’s Office)

According to state data, the number of people undergoing court-ordered mental health treatment since April, when lawmakers expanded the court’s power to make such decisions, increased by 60% over the same period the previous year.

The data, which the state’s Office of Court Administration (OCA) provided to the Gotham Gazette after the investigation, shows that during the four-month period from April through July, a judge ordered 462 people in New York to undergo mental health treatment under the Kendra Act, a 1999 law that applies to people considered a danger to themselves or others.

During the same period last year, 288 such orders were issued statewide, including 127 — less than half of the total — in New York City. From April to July of this year, a much larger share, two-thirds of all cases, or 320 requests, took place in New York City.

But the court’s new powers, enacted through the state budget in April, don’t seem to really explain the difference. According to the State Office of Mental Health (OMH), which oversees the Kendra Act, no orders have been issued under the new legal language.

The Kendra Act—named after Kendra Webdel, a young woman pushed in front of a train and murdered in 1999 by a man with a long history of untreated schizophrenia—allows courts to order outpatient psychiatric treatment for people deemed dangerous; If the person fails to comply, they can be evaluated and admitted to a psychiatric hospital. To receive outpatient treatment, or an AOT order, the person must have been recently in and out of the hospital and exhibit violent behavior.

Expanding the Kendra Act became the focus of Mayor Eric Adams and Governor Cathy Hochhol after a series of high-profile attacks by mentally ill people were reported, although Adams also spoke of his support for greater use of AOTs during his 2021 campaign for mayor. Both Democratic executives helped lead the chorus to frame it as a key tool in public safety and mental health strategies to get people with serious mental illness, in Adams’s words, “get the care they deserve.”

It was also woven into Adams’s strategy for removing campers on the streets and, in partnership with Hochul, reaching out to the homeless living on the subway. “We are not going to be disrespectful. We don’t have the right to tell people they can’t live on the street,” Adams said at a press conference on March 30, shortly before the state budget was passed in early April. “The laws don’t allow us to do that. That’s why we’re calling for a stronger Kendra law to give people the help they need. Albany should make that decision.”

At Hochul’s insistence, Kendra’s law was amended to allow judges to renew AOT orders within six months when they consider that someone with a mental illness “significantly interferes with or limits one or more major life activities”—even when they have not offered any. New violent tendencies.

Hochul and the state legislature have also approved amendments to allow physicians to appear in court by teleconference and to require facilities to share patient records with county officials who oversee AOTs. The changes, which included renewing the Kendra Act for five years, also require the state to conduct a study on the law’s effectiveness by 2026.

“This is part of the conversation to address the situation that is particularly unfolding in New York City,” Hochhol told reporters when she announced the budget agreement on April 7. People get the medical care they need.”

When asked to comment specifically on the increase in AOTs over the past four months compared to the same period last year or the fact that the changes you want have not yet been used, Governor Hochul’s office referred Gotham Gazette to OMH. An OMH spokesperson noted that it was early in the implementation of the expanded statute and the agency was in the process of educating stakeholders.

“Since the amendments went into effect, OMH has been working to make the infrastructure changes necessary to implement the amendment,” the spokesperson, Mark Genovese, wrote in an email.

He said that because AOT programs are administered at the county level, 62 local governments “need to adjust their practices, educate all local stakeholders, including court staff, county attorneys, mental health legal services, and entities that can act as petitioners for the AOT, treatment providers, etc.”

But the increased use of Kendra’s Law suggests that petitioners seek AOTs more often after Kendra’s Law made headlines throughout Adams and Hochul’s early tenure.

OMH was unable to provide details on who initiated the AOT petitions due to “data entry delays”. When asked how many AOTs started after contact with a government employee, Genovese, an OMH spokesperson noted: “AOTs do not occur as a result of a single participation or by a single employee but are usually a coordinated effort by a team of mental health professionals who review an individual’s ability to engage voluntarily in the recommended treatment.”

A number of civil rights activists and advocates for mentally ill people have criticized and expanded the law as a due process violation and a distraction from systemic failures to engage and assist people with mental health needs under less coercive conditions.

“We don’t think we should take people to court to better serve them,” said Harvey Rosenthal, executive director of the New York Association for Psychiatric Rehabilitation Services, an organization for mental health providers. “More orders are not a sign of a well-functioning system, it’s a sign of a failing system that must rely on coercion because it doesn’t know how to effectively engage the various populations.”

Rosenthal said expanding the AOT’s criteria from serious to mere self-neglect was the most “egregious” change, describing the threshold as “too broad and too vague” and low enough to lead to chronic violations of civil rights.

As of August 4, there were 3,418 active AOT applications statewide, just up from 3,376 on the same day in 2021. Hispanics make up 65% of AOT applicants statewide and 76% in New York City, although It accounts for less than 40% of the state’s population and just over half of New York City’s population. According to OMH, 1,174 people had to undergo an assessment for noncompliance with court-ordered treatment, and 27% of these assessments — about 317 people — resulted in psychological adherence.

“We already know that mental health systems fail people of color,” Rosenthal said. “This is a great example, a terrible example, of system failure.”

State Assembly member Eileen Gunther, a Sullivan County Democrat and chair of the assembly’s mental health committee, did not advocate the Kendra Act amendment when she made statements about its non-use.

“Expanding the Kendra Act has clearly been a huge priority for the governor in this year’s budget. In my time as chair of the association’s mental health committee, I worked to convince people that individuals with mental illness are more likely to be victims of crime than perpetrators,” she wrote in Statement to the Gotham Gazette.

A Gunther spokeswoman said she believes the state’s new 9-8-8 suicide prevention hotline and new budget-funded “crisis stabilization centers” will make mental health care more accessible.

State senator Samra Brooke, a Rochester Democrat and Senate chair of mental health, did not respond to requests for comment.

Kendra Law Revisited
In public statements, Adams embraced Kendra Law and Expansions wholeheartedly. He supported the expansions of the Kendra Act during heated state budget negotiations and praised the changes Hochul eventually pushed.

In July, Adams appointed Brian Stettin, who wrote the original Kendra bill in 1999 as assistant attorney general for New York State under Elliot Spitzer, as “Senior Acute Mental Illness Counsel.”

At the height of the state budget negotiations, and three months before he joined the Adams administration, Stettin wrote a newspaper editorial The Albany Times Association describes Kendra’s Law as “the best tool we have to help the most vulnerable and mentally ill people of New York escape the endless shuttle between hospitals, prisons, and the streets.”

After passing the budget with Kendra Law’s largest expansion to date, Stettin praised the spirit behind the changes but told the Gotham Gazette that the final language had been watered down. “Unfortunately, the execution turned out to be really problematic,” he said in an interview in April, speaking in his capacity as director of policy at the Center for Advocacy for Treatment, an organization that promotes enforcement of AOT laws across the country.

“There are technical issues with the improvements which I think are weakening them and leaving them of questionable utility. I hope we can bill a cleanup maybe in the summer to fix some of those issues, because ultimately we don’t have much left in terms of useful ways to extend Kendra’s law enforcement.”

Stettin said the new legal language leaves uncertainty about whether a judge should provide a separate finding that an individual meets the AOT renewal criteria, or simply a rubber stamp for decisions by county health officials. He also said that the law contains gray areas for how doctors use the default certification option and how to share medical records with county officials.

However, like Rosenthal, Stetten also described standards around self-neglect as too vague.

A spokesperson for Mayor Adams praised the changes to the Kendra Act, but did not comment directly on the increase in AOT orders or the fact that none had been issued under the new expanded language in the four months since it became law.

“We are grateful to the governor and state for working together on these changes and look forward to continuing that work into the upcoming hearing to keep people safe and ensure they get the help they need, including the AOT where appropriate,” a spokesperson wrote in an email.

Asked if the administration is working with state lawmakers on a “cleanup bill,” Stettin also indicated he’d like to pursue before joining the administration, the spokesperson referred to their previous statement indicating their interest in “continuing” the next effort. session.

The mayor’s office did not respond to questions about the number of engagements of NYPD officers or city outreach workers that led to the AOT orders.

According to the state’s Office of Mental Health (OMH), a so-called “designated petitioner,” someone who can search for an AOT for another individual, can include an “adult roommate, parent, child adult, or sibling of a potential AOT recipient, Director of a hospital where the potential recipient of AOT is in receiving inpatient care, director of a public or charitable organization, therapist psychiatrist, licensed psychiatrist or licensed social worker, director of community services, probation or parole officers…whatever state police, workers Outreach and MTA staff are not petitioners, and therefore are not part of [state] AOT data collection process.

The mayor’s spokesperson said the city’s Department of Health and Mental Health, which contains the city’s AOT office, as well as the Department of Social Services and NYC Health + Hospitals, have been educated about changes to the Kendra Act. But the spokesperson did not say whether Adams or other senior officials had issued strategic guidance on using Kendra Act more or differently.

When asked about internal guidance, an NYPD spokesperson referred to a section in the Police Patrol Manual on Procedures for Executing Orders to Relay People to Psychiatric Facilities that was last updated in October 2021, before the Kendra law was amended.