N.Y. Law Raises Issues of States' Reach in Patient Care

Across the country, supporters of such programs, known as preventive outpatient commitment laws, have called them pragmatic approaches in addressing the needs of the millions of mentally ill people who are not in institutions.

But there is intense debate among experts and policymakers about whether coercive statutes would be necessary in cases in which states increase the availability of services to the mentally ill.

Maryland does not have an outpatient commitment law. The District has a standard like Kendra's Law, but it is used sparingly.

The Supreme Court commission in Virginia recommended this month that the state expand the use of outpatient treatment for those who don't meet the criteria for forced hospitalization. The panel also called for specific procedures to monitor those receiving outpatient treatment and suggested ways to enforce it. But lawmakers also expect debate over a more expansive law that mirrors the New York statute when the General Assembly convenes next month.

"These arguments over outpatient commitment are some of the most emotional and contentious debates you'll find in mental health law," said Jeffrey Swanson, a professor of psychiatry and behavioral sciences at Duke University who is involved in a three-year study of Kendra's Law for the state of New York. "It really goes to the heart of whether we believe community mental health care can be effective without coercion and at what point we're willing to say that coercion might be necessary, legitimate and humane."

The New York statute outlines the responsibilities of local mental health agencies, spells out monitoring requirements and incorporates provisions for ordering noncompliant mentally ill people into hospitals. Those who are taken into outpatient treatment under Kendra's Law get immediate access to services. The petition process can be started by a roommate, parent, spouse, adult child or sibling, a hospital director or a caseworker, among others.

"There was nothing I could do to get her into any help before this," said Chris Wezel, 50, Susan Wezel's husband.

New York officials say the law has been effective. They conducted a survey in 2005, when the measure was up for reauthorization. The study found that a sample of patients treated under Kendra's law were more likely to participate in care, take their medication and follow up with caseworkers than when they were not treated under the law.

In addition, for those treated under the law, homelessness, arrests, hospitalizations and incarcerations dropped at least 74 percent and as much as 87 percent, the statewide survey found. Other studies conducted by mental heath researchers over the years have found similar outcomes the longer that mentally ill people stay in such coerced treatment programs.

"Coercion does work, if it's done the right way," said Mary T. Zdanowicz, former executive director of the Treatment Advocacy Center in Arlington County. She said that Virginia needs a law "that incorporates involuntary treatment, both inpatient and outpatient." Such laws get patients complete help the first time, rather than partial help over and over, she said.

But opponents of Kendra's Law say that the New York study did not use a control group for comparisons. The state's legislators were so skeptical of the available research that they called for a separate study and declined to make the law permanent. That study is due in 2009, and the law will come up for reauthorization a year later.

Advocacy groups and other mental health experts who oppose Kendra's Law say that it came with money for services, proving that coercion alone is not a solution.