A controversial New York state law that allows judges to order outpatient treatment for persons who are severely mentally ill and meet certain conditions, such as a history of violent behavior or repeated hospitalizations, may reduce the public costs associated with caring for these individuals, according to analysis published in the American Journal of Psychiatry.
Several violent incidents in New York committed by people with untreated severe mental illness, including the death of Kendra Webdale, a 33-year-old New York woman who was killed when a man with untreated schizophrenia pushed her in front of a subway train, prompted state legislators to pass Kendra’s Law in 1999. The law requires mandatory outpatient treatment for individuals with serious mental illness who refuse voluntary treatment and either have been repeatedly hospitalized or have committed violent acts or threatened violence. Tight state budgets and concerns about whether the law violates the rights of those with mental illness have made the law controversial.
An analysis of the cost-effectiveness of the law, which was mandated by reauthorization legislation in 2005, found substantial cost savings. The researchers examined the health care, social service, and criminal justice costs accrued by 634 individuals before and after receiving mandatory outpatient treatment and 255 individuals receiving voluntary care. The average total costs for those treated under Kendra’s Law declined in New York City by 50% (from $104 753 to $52 386 per person) from the year before individuals were required to begin mandatory treatment to 2 years after mandatory treatment began. Costs declined even more, by 62% (from $104 000 to $39 000 per person) for those living in surrounding counties. Second-year costs declined 13% in New York City and 27% in the surrounding counties. Costs for those enrolled voluntarily in community-based mental health care declined from $7056 to $4549 per person in New York City during the first year of care and from $4420 to $3457 per person in the surrounding counties.
Most of the savings were associated with reduced hospitalizations, according to the authors. They caution that there may be less of a cost savings for individuals who have not been hospitalized before initiation of mandatory outpatient treatment.
“These are people who are extraordinarily ill and for whom long periods of hospitalization have previously been the only solution,” said Marvin S. Swartz, MD, study coauthor and head of the division of Social and Community Psychiatry at Duke University. “This shows that these patients can be successfully treated in the community with intensive programs and a court mandate.”