Kendra’s Law shows positive results but also could be harming patients, report shows
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A new report from the University of Pittsburgh shows that clients of assisted outpatient treatment programs ordered by the courts regularly report feeling they were misled and had their agency taken away. Photo via University of Pittsburgh/New York Office of Mental Health
By Noah Powelson
As lawmakers consider whether to extend a controversial law that allows for mentally ill people to be involuntarily committed, a new report shows the law’s implementation may be doing unseen harm.
The new report from the University of Pittsburgh found that New York patients who were forcefully committed to an assisted outpatient treatment program, as allowed by Kendra’s Law, showed significant mental health improvements, but the coercive aspects of the program risks additional harm to the patients.
The report, which was first reported by POLITICO, compared outcomes of patients who were committed to an AOT to those who received similar services in a voluntary program. Research and interviews with patients showed both cohorts, whether committed or there on a voluntary basis, had positive outcomes that led to overall shorter hospital stays and reduced risk of harm.
But those committed to an AOT program, according to the report, regularly said they felt fear, stigma, a loss of autonomy, ongoing pressure and felt misled during their program.
“Qualitative findings highlight widespread concerns about coercion and lack of agency,” the report read. “People under AOT frequently describe compliance…as driven by fear of consequences rather than agreement with treatment.”
While many clients in the report said the AOT had prevented them from self-harm or drug use, most also told researchers they felt negative impacts on their self-confidence, psychological distress, a sense of powerlessness and other negative aspects as a result.
One client said that travel restrictions as part of their AOT limited their employment and broader life options, which negatively impacted their mental health.
“Emotionally, I guess it feels like I have no control over where my life is going,” the client said during an interview included in the report. “And sometimes I feel very stuck. It makes me feel depressed that I can't just start over.”
Governor Kathy Hochul has previously called for the expansion of Kendra’s Law and the use of assisted outpatient treatment programs. AP file photo by Jeenah Moon
The report also showed that it was exceptionally rare for a judge to deny a petition to involuntarily commit someone to an AOT. Statewide, judges have received over 36,000 AOT petitions since Kendra’s Law was enacted in 1999, and have only denied 4.4 percent of that total.
Many people under AOT, according to the report, testify not understanding how or why orders are extended and experience renewals as automatic, which they say contributes to a sense of indefinite oversight.
Because a lack of understanding of AOT orders was regularly reported among clients, the report recommended providing clear, plain language information about AOT rights, requiring client verification for how an AOT works and in general expanding access to voluntary services.
“These findings suggest that efforts to encourage utilization of voluntary services and better inform people meeting AOT eligibility criteria about voluntary options will likely divert a substantial number from court-mandated treatment,” the report read. “The evidence suggests that AOT’s primary positive impact lies in facilitating access to services, but that AOT’s legal and procedural framework is associated with persistent concerns about fairness, voice, and agency across all phases of implementation.”
The report was commissioned by the New York Office of Mental Health at the direction of state lawmakers, who made it a condition of reauthorizing Kendra’s Law in 2022. The legislature will need to pass another extension by June 30, 2027.
Justin Mason, a OMH spokesperson, said that the report showed AOTs were proving successful in improving community safety and reducing hospitalizations, even more so compared to voluntary services.
“This report illustrates how Assisted Outpatient Treatment is positively impacting the very outcomes it was designed to address – reducing hospitalizations and improving community safety,” Mason said in a statement. “Compared with individuals voluntarily receiving intensive community-based services, individuals on AOT experienced better outcomes related to improved housing stability, reduced risk of harm to others, reduced risk of psychiatric hospitalization, and reduced length of psychiatric hospitalization.”
“We will continue to review the findings and recommendations to ensure this small but critical component of our state’s outpatient community-based care system continues fulfilling the key role it plays in our continuum of care,” Mason added.
Kendra’s Law authorizes treatment orders for seriously mentally ill people who are at risk of harming themselves or others and are not likely to seek care themselves. If the alleged mentally ill individual meets certain criteria, including frequent mental health hospitalizations, violent behavior or increasing symptoms, a court may order that individual into an assisted outpatient treatment program.
The law, which was named after Kendra Webdale, who died after being pushed in front of a subway train by Queens man Andrew Goldstein, who had been diagnosed with schizophrenia, has been heavily criticized by legal advocates. Critics say the law heavily infringes on New Yorker’s civil liberties and claim it is inefficient compared to voluntary services.
In 2022, when Kendra’s Law was up for another extension, the New York Civil Liberties Union called on the legislature to discontinue the law.
“For more than 20 years, Kendra’s Law has denied people the fundamental right to determine the course of their medical treatment,” the NYCLU said in a statement at the time. “Kendra’s Law unconstitutionally expands the circumstances under which the State may compel people with mental health challenges to undergo treatment against their will or to participate involuntarily in mental health programs, including potential hospitalization and/or medication.”
