Behavioral Healthcare

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Researchers at the Mailman School of Public Health have determined that mandatory outpatient treatment for New Yorkers with severe mental illness leads to a drop in violent criminal behavior.

According to the researchers, the study is the first to fully assess the merits of Kendra’s Law, enacted in 1999, which mandates outpatient care for New Yorkers with psychotic disorders and other mental illnesses. Named after Kendra Webdale, who died after being pushed in front of a New York City subway train by a schizophrenic man who had skipped treatment, the temporary law is set to expire this summer. It has also become controversial; many critics question the method of forcibly coercing patients into treatment, fearing elevated stigma, decreased self-esteem and compromised civil freedoms.

The researchers studied patients in New York City clinics for a year between 2003 and 2006. They studied 76 mentally ill individuals ordered to undergo outpatient care due to histories of violence and non-compliant behavior. The researchers then compared them with a control group of mentally ill outpatients enrolled in the same clinics, but placed into less intense treatment programs because they demonstrated fewer propensities toward violent behavior and were more likely to follow through with treatment regimens.

According to the researchers, the individuals 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. The researchers also noted that people who underwent mandatory treatment reported higher social functioning and slightly less stigma, rebutting claims that mandatory outpatient care is a threat to self-esteem.

More than 1,800 New Yorkers are currently enrolled in a court-ordered outpatient treatment program through Kendra’s Law. According to Bruce Link, Ph.D., professor of epidemiology and sociomedical sciences at the Mailman School, director of the Center for Youth Violence Prevention, and lead investigator of the study, there are clear benefits to such involuntary care. “Our study has found that Kendra’s Law has lowered risk of violent behaviors, reduced thoughts about suicide and enhanced capacity to function despite problems with mental illness. Outpatient commitment for people with mental illnesses is enormously controversial — it’s been heralded as necessary and effective by some, and as overly coercive and counterproductive by others — but our study has found few of the negative consequences feared by critics of Kendra’s Law.”

However, the real take-home message of the research, according to Dr. Link, is that a policy that provides enhanced treatment for people with serious mental illnesses can improve their life circumstances and reduce the risk of violence. At present, 42 states have laws mandating outpatient care for individuals with severe mental illnesses.

Source: Mailman School of Public Health, February 18, 2010