NYS is currently holding hearings and accepting write in testimony on how to comply with the Supreme Court decision, Olmstead v. L.C. That decision held that Title II of the ADA requires services for persons with mental illness be provided in the “most integrated setting appropriate to the needs of the disabled, considering available resources".
We believe that using Kendra's Law more can help accomplish that because it is proven to reduce the use of more restrictive settings like incarceration and inpatient commitment. Unfortunately, those who scheduled the hearings did not schedule any hearings in jails, prisons, or psychiatric hospitals, the three most restrictive settings. As a result, the testimony they are likely to hear will not reflect the thoughts of persons in the most restrictive settings, the professionals who provide care for them or their families.
You can send your own thoughts on how to serve people with mental illness in the least restrictive, most integrated settings to raymond.l.pierce@opwdd.ny.gov echoing the below to or fill out the form at http://www3.opwdd.ny.gov/wp/wp_catalogz2414.jsp . You can learn more about Kendra's Law at http://kendras-law.org
Testimony of DJ Jaffe
NYS
Olmstead Implementation Plan Public Hearing
August
21, 2012
NYS is required to make greater
use Kendra’s Law to ensure individuals with mental illness receive treatment in
the most integrated setting as required by Olmstead v. LC
Failure to use Kendra’s Law could
create liabilities for the state and localities.
“It is a common phenomenon that a
patient functions well with medication, yet, because of the mental illness
itself, lacks the discipline or capacity to follow the regime the medication
requires.” . (Olmstead V. L. C. (98-536) 527 U.S. 581
(1999))
It
must be remembered, for the person with severe mental
illness who has no treatment the most dreaded of confinements can be the
imprisonment inflicted by his own mind, which shuts reality out and subjects
him to the torment of voices and images beyond our own powers to describe....
(Olmstead V. L. C. (98-536) 527 U.S. 581 (1999))
1. New Yorkers with serious
mental illness are not living in most integrated setting
- 15,000 New Yorkers with mental illness are living in jails and prisons
- 4,000
New Yorkers with mental illness are living in state psychiatric
hospitals
- In NY you are more likely to be incarcerated
for mental illness than hospitalized.
2. The problem is not lack
of “available resources.” NY has “available resources”
*
NYS spends in excess of $3 billion on mental health
*
Individuals with serious mental illness are largely excluded from OMH programs
especially if they lack the ability to volunteer. The seriously ill go to the
end of the line while worried well go to front.
*
OMH has never improved services for the most seriously ill, absent a court
order.
*
$665 million of OMH budget (1/3) wasted per Dr. Llloyd Sederer: “Thus, taken
together, $665 of the $814 (more than 80 percent!) was spent, perhaps
unnecessarily, on people with mental disorders, principally for the serious
medical illnesses that they frequently suffer.”
* OMH refuses to focus existing
resources on the most seriously ill. OMH serves
650,000. Only 3,600 are seriously mentally ill individuals in state hospitals
and 1,871 are in assisted outpatient treatment programs. Maybe 100K are in
other programs that help seriously mentally ill.
OMH policies transfer the
seriously ill to shelters, prisons and jails in violation of Olmstead.
3. Kendra's Law research shows it can help people live in the least restrictive most integrated setting
Once
enrolled in Kendra’s Law
· 77% fewer experienced psychiatric hospitalization
· On average, AOT recipients' length of hospitalization
was reduced 56% from pre-AOT levels.
· 83% fewer experienced arrest
· 87% fewer experienced incarceration.
March 2005 N.Y. State Office of Mental
Health “Kendra’s Law: Final Report on the Status of Assisted Outpatient
Treatment. “
· Individuals who received court ordered treatment in
addition to enhanced community services spent 57 percent less time in psychiatric
hospitals than individuals who received only enhanced services.
·
Individuals who had
both court ordered treatment and enhanced services spent only six weeks in the
hospital, compared to 14 weeks for those who did not receive court orders.
1998 Policy Research Associates, Inc. Research study of
the New York City involuntary outpatient commitment pilot program.
Patients
given mandatory outpatient treatment - who were more violent to begin with -
were nevertheless four times less likely than members of the control group to
perpetrate serious violence after undergoing treatment.
February 2010 Columbia University. Phelan,
Sinkewicz, Castille and Link. Effectiveness and Outcomes of Assisted Outpatient
Treatment in New York State Psychiatric Services, Vol 61. No 2
For
those who received AOT the odds of any arrest were 2.66 times greater and the
odds of arrest for a violent offense 8.61 times greater before AOT than they
were in the period during and shortly after AOT. The group never receiving AOT
had nearly double the odds of arrest compared with the AOT group in the period
during and shortly after assignment.
March 2005 N.Y. State Office of Mental
Health “Kendra’s Law: Final Report on the Status of Assisted Outpatient
Treatment. “
(AOT)
improves likelihood that providers will serve seriously mentally ill: It is
also important to recognize that the AOT order exerts a critical effect on
service providers stimulating their efforts to prioritize care for AOT
recipients.
June 2009 D Swartz, MS, Swanson, JW, Steadman,
HJ, Robbins, PC and Monahan J. New York State Assisted Outpatient Treatment
Program Evaluation. Duke University School of Medicine, Durham, NC, June, 2009
Providers
of both transitional and permanent housing generally report that outpatient
commitment help clients abide by the rules of the residence. More importantly,
they often indicate that the court order helps clients to take medication and
accept psychiatric services.
1999 NYC Dept. of Mental Health, Mental Retardation and
Alcoholism Services. H. Telson, R. Glickstein, M. Trujillo, Report of the
Bellevue Hospital Center Outpatient Commitment Pilot
Research in numerous
other states support the proposition that AOT enables individuals with serious
mental illness to live in the least restrictive most integrated setting.
To be compliant with
Olmstead, NY must make greater use of Kendra’s Law. To offer humane care for
the most seriously ill NY should make use of Kendra’s Law.
To learn more, visit http://kendras-law.org
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