The mid-20th century witnessed the deinstitutionalization movement. Spurred by toxic conditions in psychiatric hospitals and the development of anti-psychotic drugs that would permit residents to function outside their walls, these establishments began to shut their doors in droves. Community treatment, recognized as superior in theory, often failed to deliver in fact. Not only was it chronically underfunded, but also the mentally disabled often refused to utilize such services as did exist. Without monitoring, many individuals who needed medication to live more or less normally stopped taking it because they did not believe they were sick (or to avoid its side effects). As a result, a “revolving door” pattern developed: People would go “off their meds,” decompensate, be hospitalized and resume medication, briefly improve, then be released and repeat the cycle.
Against this backdrop, a series of attacks involving mentally ill assailants provided the direct impetus in several states for passage of so-called assisted outpatient treatment (AOT) statutes; 43 jurisdictions have them. These permit court-ordered therapy in the community, including psychotropic drugs, for individuals meeting the statutory criteria who are not voluntarily receiving services. The best known is the eponymous “Kendra’s Law,” N.Y. Mental Hyg. Law § 9.60, enacted in 1999 in the wake of the death of Kendra Webdale, whom a recently discharged mental patient pushed off a subway platform. It is slated to sunset in June. The debate between supporters and opponents will furnish an occasion to review the merits of not just this law but also AOT in general.
