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The New York City-Bellevue Controlled Trial

A second random assignment study of outpatient commitment involved a pilot program established in 1994 at New York City’s Bellevue Hospital. Seventy-eight individuals received court-ordered treatment and an enhanced services package, while 64 control subjects received only the enhanced services package. At 11 months post hospital discharge, no significant differences in outcome were found between the two groups, as evidenced by hospitalizations, arrests, quality of life, symptomatology, treatment compliance, and perceived level of coercion (Steadman et al., 2001).

Non-Experimental Studies of New York’s Kendra’s Law

A series of three non-experimental studies of outpatient commitment were carried out in New York State, involving a statewide implementation of Kendra’s Law (New York State Mental Health Law 9.60, August, 1999).[1]

The New York State Office of Mental Health conducted a descriptive study of the outcome of Assisted Outpatient Treatment for 3,766 individuals enrolled in the program. Compared to the period prior to receipt of assisted outpatient treatment, at six months after termination of assisted outpatient treatment, patients experienced an 87 percent decline in incarceration, an 83 percent decline in arrests, a 77 percent decline in psychiatric hospitalizations, and a 74 percent decline in homelessness. Harmful behaviors, social functioning, and self care also improved (NYS OMH, 2015).

A legislatively supported second study of the outcome of Kendra’s Law was carried out using AOT administrative data from the New York State Office of Mental Health and Medicaid claims over an eight-year period from the time the law was passed in 1999 to 2007. Findings from this study of 3,576 individuals who received AOT revealed a nearly 25 percent reduction in psychiatric hospital admissions during the initial six- month period of the court order compared with the period prior to the court order, and when the court order was renewed for an additional six months, the hospitalization rate was further reduced. Reductions in the number of days hospitalized were also observed. In addition, improvements in the receipt of psychotropic medications, case management services, and engagement in outpatient care were found (Swartz et al., 2010). Improved rates of receipt of medication and reduced hospitalizations were more likely to be sustained post AOT when the intervention was kept in place longer than the initial six-month duration of the program (vanDorn et al., 2010).

A third New York State study compared the outcome of 76 individuals mandated to AOT with 108 recent hospital discharges without AOT who were attending the same outpatient programs as those with AOT. The study employed propensity score matching and generalized estimating equations to maximize causal inference in the absence of experimental design. Findings revealed that suicide risk and violence perpetration were lower in the AOT group, and the AOT group experienced improved functioning. No differences in psychotic symptoms or quality of life were observed in the two groups, and the AOT group was somewhat less likely to report feelings of stigma and perceived coercion compared to the outpatient only group (Phelan et al., 2010).

  • [1] The law was named for Kendra Webdale, who was pushed in front of a New York Citysubway train by a man with a history of mental illness and multiple hospitalizations.
 
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