What’s behind the increased use of Kendra’s Law in New York?

Mayor Adams takes the subway (photo: mayor’s office)

When Mayor Eric Adams was on the campaign trail last year, he repeatedly called on city and state officials to step up the use of Kendra’s Law – a state law that allows court-ordered outpatient mental health treatment for those deemed dangerous to themselves or others.

“We must strengthen Kendra’s law”, Adams told the press in front of a metro station in May 2021.

“Judges, do your job. It’s time to use Kendra’s Law to address the mental health crisis we are experiencing,” he said.

Adams took office in January and, along with Governor Kathy Hochul, has focused on “subway safety,” homelessness and untreated mental illness. With the presence of people with serious mental illnesses more visible on the subways and streets in some parts of the city, the crisis has been further aggravated by high-profile incidents, in particular the January murder of Michelle Go, who was pushed in front of a train. by a man with schizophrenia. Earlier this year, Hochul, with support from Adams, reinforced Kendra’s Law in the state budget and both made public statements about it.

This message appears to have reached the city’s pool of law enforcement and social service agencies.

The number of Kendra’s Law ordinances statewide increased slightly in August, from about 3,400 to 3,500, and remained high for much of September. Although the statewide increase was slight, it was almost entirely due to New York City, which saw a significant increase in treatment orders in all five boroughs while there were declines in most of the rest of the state.

The Adams administration and the city’s Department of Health and Mental Hygiene (DOHMH), which administers the ordinances, reported little official guidance related to the use of AOT petitions or Kendra’s law.

Asked to respond to the numbers, the Adams administration did not report any specific efforts to increase the use of Kendra’s Law and AOT.

“The Adams administration is focused on keeping New Yorkers safe and caring for the most vulnerable among us. We will continue to make sure people get the help they need, including the AOT if applicable,” a city hall spokesperson wrote in an email.

To be placed under what is called “assisted outpatient treatment” (AOT), a person must exhibit violent behavior and have been hospitalized several times for a mental health disorder. AOT often involves taking psychotropic drugs and various forms of therapy. If a person does not comply, they may be involuntarily committed to a psychiatric hospital.

Typically, a county health department — in this case, NYC DOHMH — applies to the court after receiving a referral, often from an outreach worker, outpatient provider, or member of family, or other city agencies like the Department of Social Services. In the past 12 months (since September 2021), New York judges have granted 90% of AOT motions (slightly down from 96% of motions granted since 1999).

Proponents, like Adams’ senior adviser on serious mental illness Brian Stettin, an attorney who helped draft Kendra’s law in 1999 as deputy attorney general, say the law helps a subset of people with mental illness to receive expedited care and avoid unnecessary hospitalizations and criminal charges. – legal implication. Some civil rights advocates and advocates for people with serious mental illness call the system coercive, with language that is too broad and often used to violate constitutional rights.

In New York, 44% of current AOT recipients are black and 32% are Latino, according to state data. About a quarter have experienced homelessness, incarceration or both. More than half have problems with alcohol or substance use. Current rates suggest that a quarter of AOT orders will result in hospitalization.

As of September 22, the number of people on AOT in New York City had risen to 1,655, nearly half of the state’s total, and a remarkable 19% increase from the same day last year. Long Island was the only other region in the state to see an increase, overshadowed by both the pace and volume of the city. Every area north of the Bronx saw a decline in AOTs year over year.

The rise came on the heels of an increase in new AOTs in New York from April to July, despite falling rates elsewhere in the state. This has raised questions about the importance the Adams administration places on using Kendra’s law outside of its bullying pulpit.

In February, weeks after Go was fatally pushed in front of a moving train, Adams unveiled his Metro safety plan. The centerpiece of the campaign was to flood the subways with community workers and police, and push state lawmakers to change Kendra’s law.

“It is cruel and inhumane to allow homeless people to live on the subway, and unfair to pay transit passengers and workers who deserve a clean, orderly and safe environment,” Adams said in a statement to the time.

“The days of turning a blind eye to this growing problem are over, and I look forward to working with state, federal, TWU, attorneys and law enforcement to address this issue,” said the new Democratic mayor.

Adams’ plan called for an inter-agency review of the entire AOT system, to “identify efficiencies and ensure clients are placed in the best care pathway for their needs.” .

A city hall spokesperson said the review was ongoing but declined to provide details on its status or findings so far.

In April, after a push by Hochul echoing Adams’ calls to expand Kendra’s law, state lawmakers expanded the law to include self-negligence in addition to dangerousness. This has allowed local health departments to extend mandatory treatment into six months after expiry without evidence of violent behavior, so long as an individual is unable to carry out “one or more major life activities” due to of a mental illness.

“Governor Hochul’s top priority is to protect New Yorkers, and she has made the development of a comprehensive behavioral health crisis system in New York State a key initiative of her administration,” said Justin Mason. , spokesperson for the Executive Chamber, in response to the latest increase. in AOT.

“Governor Hochul has worked with the Legislature to implement the most substantial amendments to Kendra’s law in two decades to strengthen the use of the law and the results,” Mason continued. “By investing millions of dollars in mental health services and working closely with providers, local government and law enforcement to help vulnerable people get the care they need, Governor Hochul is taking meaningful action to protect the health and safety of New Yorkers in need.”

The state’s Office of Mental Health (OMH) met with county health departments, state courts, and state-appointed attorneys across the state to advise them of the changes to the law, Mason said. The OMH has also updated the guidance documents available on its website.

According to the mayor’s office, the city trained officials from DOHMH, New York City Health + Hospitals and the Department of Social Services on the changes to the law.

The administration also sent city agencies a February guidance letter from OMH Commissioner Anne Marie Sullivan, appointed by former Gov. Andrew Cuomo, which defined dangerousness as self-neglect before the change. be codified in Kendra’s expanded law in the spring.

But according to OMH, the more expansive language was not the basis for new commands.

From April to July, as the number of new orders surged, the total number of people on AOT remained stable around 3,400, indicating that people were leaving AOT as quickly as they were leaving.

The reason, according to a spokesperson for the city’s Department of Health and Mental Hygiene, which handles nearly all AOT petitions in the five boroughs, “is that during the latter part of the pandemic, some AOT orders expired without renewal due to pandemic-related issues with the court system,” leading to a reduction in the AOT census.

“A lot of these stale cases were reopened as investigations and, when the courts started to work better, moved back to AOT,” the city’s health department spokesperson told Gotham Gazette. “These, in addition to the usual new referrals each month, have helped the AOT Census recover.”

When asked why courts were able to process new orders so quickly but could not keep up with lapsed orders, another DOHMH spokesperson explained that courts could not review expiring orders “when their operation was curtailed during the pandemic,” leaving DOHMH to resubmit AOT petitions after the fact.

Lucian Chalfen, spokesman for the state justice system, appeared to deny the claim that judicial functions had come to a halt. “We have continued to hold hearings throughout the pandemic as we were set up for virtual appearances prior to March 2020,” he wrote to Gotham Gazette in an email response to the statement from the DOHMH.

Amid the current AOT surge, the biggest jump has been in Manhattan, which saw a 25% year-over-year increase, followed by Queens, Brooklyn, the Bronx and, modestly, Staten. Island. The particular uptick in Manhattan appears to align with Adams and Hochul’s emphasis on targeting policing and outreach to the epicenter of transit hubs. The NYPD recently reported interacting with more than 40,000 homeless people in the transit system this year, including 7,700 services accepted.

In mid-September, representatives from the OCA and Mental Hygiene Legal Services, a branch of the court system, the DOHMH Legal Division, and more than a dozen other stakeholders, including healthcare providers ‘AOT, met to discuss ways to expedite mental health cases. It was “a regular meeting,” according to Halfen. The second item on the agenda was “treatment orders”, he said.

Neither Chalfen, DOHMH, nor City Hall will comment on what was discussed or who was present. A spokesperson for the town hall confirmed that the meeting had taken place, focusing on the judicial calendar. The spokesperson said it was not specific to AOT orders but did not deny that the orders were discussed.

About Kevin Strickland

Check Also

Inflation in Argentina reaches 100% creating poverty and unrest

Inflation in Argentina heading towards 100% is fueling government woes as real wages lag, increasing …