Signed by the Governor on the ninth day of August in 1999, Kendra’s Law was created simply to enforce safety for absolutely everyone when it comes to interacting with or being exposed to a mentally ill person in the state of New York. Action was taken fairly quickly after an unfortunate tragedy in January 1999, involving an innocent young woman named Kendra Webdale who had been fatally pushed in front of a train by a man suffering from a long history of mental illnesses. Sadly, these types of disasters occur every single day, all over the world. While Kendra’s Law may seem like a controversial topic to some, the lawmakers of New York had used Kendra’s unfortunate death in a positive manner to create this law, which would help to prevent similar ill-fated accidents which might be likely to occur in the city’s future.
Along with every other topic which affects a community, there will always be both pros and cons regarding the subject. When it comes to Kendra’s Law, we already know that the pros include (but are not limited to): increased safety within the community, better monitoring and supervision of at-risk mentally ill patients, and increased patient participation within the treatment program. Some of the cons related to Kendra’s Law include: infringing on patients’ civil liberties, patients are forced to take medication against their will, and decreased patient trust in their doctors.
As evidence to back up the pros of Kendra’s Law, researchers have stated that “the odds of arrest among AOT recipients in the sample were relatively low while they were enrolled in the program. Possible reasons are increased engagement in intensive case management services, including ongoing supervision and monitoring of behavior, and increased adherence to appropriate psychotropic medications,” (Gilbert et al., 2010). With the arrest rate decreasing for mentally ill individuals and the increase of willing participation from the individuals, it seems as though Kendra’s Law is creating a positive effect on communities in New York.
Regarding the associated cons related to Kendra’s Law, many feel that patients’ rights are being completely violated. According to an article published in May 2011, “Government agencies seeking to force the mentally ill to undergo treatment cannot access a patient’s health records without the patient’s knowledge,” (Stashenko, 2011, p. 1). Due to privacy laws in the Health Insurance Portability & Accountability Act (HIPPA), patient records cannot be accessed without a court order or subpoena, in which both cases the patient must first be notified. In the case of Miguel M. (Anonymous), Appellant vs Charles Barron, Respondent, Miguel presented proof to the court that his HIPPA rights had been violated when he was sent to outpatient treatment without knowledge that his medical records had been released, let alone requested by the State agency. From another aspect, patients’ rights could also be seen as being violated in regards to their constitutional right to bear arms. According to the New York Secure Ammunition and Firearms Enforcement Act, “the Brady Act prohibits the receipt or possession of firearms by an individual who has been adjudicated as having a mental disability or has been involuntarily committed to a mental institution,” (2013). Some might view this as a pure violation of a United States citizen’s right to bear arms – however, it is absolutely unsafe for a mentally ill individual to carry a gun, especially if they are considered to be unstable. This could potentially cause fatal accidents, violent crimes or even increased suicide rates. Another con related to the law is in regards to the patient-doctor relationship. By being forced into an outpatient program, the patient could potentially misunderstand the doctor’s role in their medical relationship. This could possibly occur by mistakenly believing that the doctor is only following government orders rather than properly diagnosing or medicating the patient on his/her own terms. The distrust developed in this type of situation could eventually lead to attempted non-compliance with the outpatient program.
When it comes to the social policy concerns related to Kendra’s Law, it is understandable that some might feel uneasy with the thought of mentally ill patients possibly being treated unfairly due to their conditions. Some might argue that after fighting to rid this country of all of the inhumane psychiatric hospital warehouses over so many years, integrating an outpatient program forcing patients to follow strict treatment orders is taking a step in the wrong direction. However, many patients are more than willing to enter into outpatient programs because they so badly do not want to go to jail for carrying out preventable criminal actions in the community. They understand that the program is intended to intervene and prevent them from going down the wrong path, protecting the patient and everyone else in the community.
Both safety and order play such an important role when enforcing Kendra’s Law in the community. All patients within the program are constantly monitored during treatment, especially those who are at risk for violence, possibly causing harm to themselves or others. Each mentally ill individual is required to stay in the outpatient program for a mandatory time period of six months to one year. They are placed under review prior to being released, mainly to ensure that they no longer pose a threat to themselves or others and can maintain a balanced life back in the community. The main purpose of enforcing Kendra’s Law is to ensure safety for the patient as well as for the other members of the community.
If Kendra’s Law was shown to be effective in bettering the recidivism rate related to mentally ill persons, it would certainly prove that the law is necessary as it positively benefits the community as a whole. The whole purpose behind Kendra’s Law is to locate mentally ill patients who have a history of non-compliance, violence or other criminal activity, and provide them with a treatment program which will help them balance out their life in a positive manner and to help them understand the difference between wrong and right. They are provided with the knowledge, counseling and necessary medical treatment to help them live a balanced life. They will be monitored regularly by taking a urine test to ensure that they are indeed taking their necessary medication, which means they will be far less likely to act out violently or with criminal intent. With fewer arrests, the community will also benefit by having a much lower crime rate.
There are still underlying social policy influences and issues, especially regarding patients being treated humanely and fairly. In no way are the patients being treated unfairly or unlawfully when placed into an outpatient treatment facility for their mental illnesses. They are provided with all of the information regarding their treatment, progress and future plans regarding their medical treatment. If a person is not competent to understand the treatment they are to undergo, then they will likely be assigned a guardian or Power of Attorney, which would ensure all steps taken are both fair and legal for the patient. According to the Clinical Manual of Psychiatry and Law, “providing and recording full disclosure to patients is, with certain exceptions, the best policy medically, ethically, and legally,” (Simon & Shuman, 2007). The adherence to the HIPPA Act will also ensure that patients are treated fairly when it comes to their medical treatments.
When the larger social, political economic factors involved with the implementation of Kendra’s Law are examined, there are many different viewpoints for sure. Some might argue that the law is simply not constitutional. To this we can explain that the state of New York has both the responsibility to help people who cannot help themselves and the responsibility to prevent people from causing harm to others. The first responsibility involves medical treatment and care, while the other responsibility involves preventing crime by putting offenders in jail. The balance of these two responsibilities is the assisted outpatient treatment, which caters to both separate parts of the state’s responsibilities, and is absolutely constitutional. On a larger social and political scale, many states other than New York have also enacted similar laws, but unfortunately do not enforce them as strongly as New York. Additionally, it may seem as though low-income individuals, homeless individuals or minorities may be targeted more than others to be coerced into this type of treatment. There are also the economic factors, mainly the costs to enforce Kendra’s Law, which is actually quite expensive. According to an article from the Wall Street Journal, executive director of the NY Association of Psychiatric Rehab Services, Harvey Rosenthal says, “Kendra’s law spends a lot of money trying to force a small number of people into treatmentit misuses precious resources that really distract us from what’s really needed: a fully responsive, accountable, engaging mental health service system,” (Hollander & DeAvila, 2013).
Although Kendra’s Law may still be considered a controversial one by some, the benefits seen thus far since enacting the law have certainly outweighed the negative issues. Not only does the law provide a sense of security for the members of the community, but it also provides the necessary treatment for mentally ill patients to help them to live a better and safer life. With some slight tweaking to law to appease the social policy concerns, this law could likely be the model for all other states to follow, which would provide increased safety across the country.
References
Gilbert, A., Moser, L., VanDorn, R., Swanson, J., Wilder, C., Robbins, P., Keator, K., Steadman, H., Swartz, M. (2010). Reductions in Arrest Under Assisted
Outpatient Treatment in New York. Psychiatric Services, 61.
Hollander, S., & DeAvila, J. (2013). 'Holes' Are Seen in Kendra's Law. The Wall Street Journal. Retrieved from http://online.wsj.com/news/articles/SB10001424127887 323936804578230180937699290.
New York Reports (2011). In the Matter of Miguel M. (Anonymous) & Charles Barron. Court of Appeals. No. 76.
NYS Office of Mental Health (2013). New York Secure Ammunition and Firearms Enforcement Act. New York City.
Pataki, G.E. (2005). Kendra’s Law – Final Report on the Status of AOT. Office of Mental Health.
Simon, R.I., & Shuman, D.W. (2007). Clinical Manual of Psychiatry and Law. Washington, DC: American Psychiatric Publishing, Inc.
Stashenko, J. (2011). Use of Records for Kendra’s Law Faulted for Violating Privacy Act. New York Law Journal.
