Renew Kendra's Law - This Time Permanently

Kendra’s Law is a New York law that allows courts to order certain violent and/or recidivist mentally ill individuals to accept treatment as a condition for living in the community. This is called Assisted Outpatient Treatment (AOT). It also allows courts to commit the mental health system to providing the treatment.

Some people, as a result of mental illness, have great difficulty taking responsibility for their own care, and often reject outpatient treatment offered to them on a voluntary basis. These individuals often commit suicide; become homeless; end up in jail; or, on rare occasions, are involved in acts of violence. Family members and caregivers often must stand by helplessly and watch their loved ones and patients decompensate to actual "dangerousness" before they are allowed to facilitate treatment. 

Kendra's Law provides residents in New York State with a tool, Assisted Outpatient Treatment, that has proven to help in these situations.

Since its original passage in 1999 and renewal in 2005, Kendra’s Law has been the subject of several studies, which found that Kendra’s Law:

• Helps the mentally ill by reducing homelessness (74%); suicide attempts (55%); and substance abuse (48%).
• Keeps the public safer by reducing physical harm to others (47%) and property destruction (43%).
• Saves money by reducing hospitalization (77%); arrests (83%); and incarceration (87%).

In anticipation of Kendra’s Law’s expiration on June 30, 2010, two bills have been introduced. The Assembly bill, A10421, introduced by Assemblymember Aileen Gunther, would not only renew Kendra's Law, but would also make it permanent.  The Senate bill, S7254, introduced by Senator Thomas Morahan, would renew Kendra's Law but allow it to expire on June 30, 2015.  

I don’t know about you, but I don’t think the problems that Kendra’s Law addresses will magically go away on June 30, 2015.  Do we want to go back to the higher numbers of homelessness, suicide attempts and substance abuse that this law has helped reduce? I don’t think so.  I think the statistics prove the worth of this law and there is no reason to have to go through another renewal process.  Kendra's Law should be made permanent.

Moreover, the Assembly bill would implement important fixes to make the current law stronger and more consistently applied; it would:

• Close the loophole whereby a person under a court order can evade the court order by moving to a different county.  This can reduces costs and provide treatment in a timely manner.
• Trigger an automatic review of the court order before it expires to determine if it should be renewed and establish a reporting mechanism to help the Office of Mental Health monitor these expirations.  This can prevent a lapse in treatment which can have devastating effects.
• Provide training to judges so the law can be applied consistently.
• Trigger an automatic review, prior to the release of patients who had been involuntarily committed to an in-patient hospital, to determine if the patient should be considered for AOT.  This can prevent a lapse in treatment, which can have devastating effects.
• Trigger an automatic review, prior to the release from prison of inmates who received mental health services, to determine if the inmate should be considered for AOT.  This can reduce recidivism.
• Provide a stronger mechanism for family member of the mentally ill and members of the community to petition the court to have a individual investigated for AOT. 
• Allow courts to consider previous behavior, not just the current behavior of an individual being considered for AOT.  This is important because it can provide insight into how the individual would survive in the community with and without treatment.
• Provide a mechanism to bring Kendra’s law to smaller communities that do not have qualified doctors.  Thus, it expands the benefits of Kendra’s Law to help all communities, not just the larger ones.
• Require physicians to make reasonable efforts to gather useful information from the consumer’s family and significant others in order to develop a treatment plan.  Often family members can fill in gaps that the consumer does not, or is not able to, provide.
• Incorporate research that shows treatment plans of one-year have been more useful to consumers and would allow AOT plans of one-year, not just six months, to be ordered.  This can not only improve outcomes, but also it reduces costs associated with each renewal.
• Improve the renewal process when an otherwise qualified petitioner other than the original petitioner requests a renewal. This avoids additional court hearings, which saves money
• Allow individuals who materially violate their order to be taken to a hospital for admission assessment without holding a new hearing that could delay treatment. (This does not mean the individual would automatically be admitted for in-patient care, rather it eliminates requiring a court order for the evaluation.)
• Eliminate the need of having a psychiatrist testify in court if the consumer and attorney, want to stipulate to the psychiatrists findings.  This saves money.

The Senate bill has no such fixes.

The choice is obvious to me.  Not only would the Assembly bill (A10421) make Kendra’s Law permanent, it would improve the law to reach more people, improve compliance, and reduce costs. 

Please contact your state representatives and urge them to support A10421. Make Kendra’s Law permanent.

For more information, please visit the New York Treatment Advocacy Coalition website.

Spread the Word: Repeal the IMD Exclusion

My nephew sent me this message today:

Hi Ilene, Dad and I had a long discussion over Easter weekend regarding the IMD exclusion. This exclusion is nothing short of disgusting. It is a prime example of how the poor and mis-fortunate are treated in our country. I apologize but I was never fully aware of how, why, and when this exclusion was enacted. Let me know how I can help!

This was my reply:

Hey Mike - thanks for writing! 

First of all, don't feel bad you didn't know - I didn't know about it until a year or so ago. It seems like most people in Congress don't really understand it either, which gets me to my first point...

The first thing you can do is write to your members of Congress and ask them to support a bill that has already been introduced to repeal the Medicaid Institutes for Mental Diseases (IMD) Exclusion. It is HR 619, and it was introduced in Jan. 2009, by Rep. Eddie Bernice Johnson of Texas. It only has one other co-sponsor and has been sitting in committee for almost 16 months.

Explain to your members of Congress that the partial repeal of the IMD Exclusion, offered by the new health insurance reform law, would not have helped Paul because it only pays for emergency hospitalization and stabilization. Paul never had trouble accessing these services - and Medicaid paid for it. What Paul needed was long-term care. Remind your members of Congress that someone with Alzheimer's can get long-term care with Medicaid subsidies, but someone with Schizophrenia cannot - that is discrimination, pure and simple.

When your members of Congress start to bring up the costs involved in paying for their care, explain to them that "we" the "tax payers" are already paying taxes to support the extra burden on our local ER departments, Ambulance companies, local hospital psych wards, police departments, courts and prisons. How they figure out how to redistribute where our money goes to cover long-term care for people with Schizophrenia, as we do for people with chronic lung disease or Alzheimer's, is their job - that's what we pay them to do - they should figure it out because "we" are already paying for this through local, state and federal taxes. The problem is that the people are still suffering because they are homeless or in prison, rather than in treatment.

The other thing I have started to do is to put pressure on my state legislator. The states need to pressure the federal government to repeal the IMD Exclusion. The states have been bearing the full burden of costs to provide long-term care, which is why they keep pushing them out quicker and sicker. The states have been balancing their budgets on the backs of people like Paul for decades. If the federal government helped with some of the costs, perhaps they would get the care they need.

Finally, you can ask all of your friends to do the same thing. The more people we educate on this issue, the more people will react the same way you have and will force the issue.

For more information on the IMD Exclusion - you can direct people to the treatment advocacy center website - or just google the term "IMD Exclusion" - there is a lot of information on it on the web.  Also, go to this article I had published in the Op-Ed News website.  When you get to the bottom, there will be an "Action" section with a  link for you to write to your members of Congress. 

Thanks again Mike!

And thanks to all of my 9 followers so far that may read this and write to their members of Congress.   Now tell your friends!

The New York Crank: America already has death panels. They're called health insurance companies.

This is the first time I have linked another persons blog to mine...This is spot on...

The New York Crank: America already has death panels. They're called health insurance companies.

Even though the health insurance reform bill has passed and is now law, the very fact that these same insurance companies are actively looking for ways to get around the law is witness to the need to read this article.

Private health insurance companies have one thing in mind - and that is to make a profit and satisfy their shareholders.  Policy holders who make claims only get in the way of profits.  Insurance companies have done whatever they can to deny claims.  This will not change now that - ta da! - Reform is here!


The only way to really change things is to have a single payer Medicare for all system.  With a 3% overhead, Medicare certainly beats private insurance.  Yes, it's not perfect, but nothing is.