A New York law that allows judges to mandate outpatient psychiatric treatment for people with severe mental illness saves the medical industry money by reducing hospitalizations, according to a new study in the American Journal of Psychiatry.
Researchers assessed 634 patients who were ordered under Kendra’s Law to participate in community care. The law was named after Kendra Webdale, who was pushed to her death in front of a New York City subway car by Andrew Goldstein, a schizophrenic who went off of his medication.
The law mandates community-based care over hospitalization for severely mentally ill patients who have a history of “revolving-door admissions” to psychiatric hospitals. These cases are generally the most expensive in the realm of mental health, but the study shows the law reduces hospitalizations and halves medical expenses for these patients.
Money and Resources Saved
Lead study author Jeffrey W. Swanson, a professor of psychiatry and behavioral sciences at Duke University, said outpatient commitment programs could make for effective state policy, at least where cost is concerned.
In the year before mandated treatment, 553 of the study subjects were admitted to hospital psychiatric units, racking up $104,000 in medical bills on average. After the program began, only 315 were admitted, with costs declining to an average of $56,803 per patient.
“In many cases, people who are opposed to outpatient commitment programs say they're going to waste money by spending public resources on a few people with court-ordered treatment, at the expense of people who want treatment and can't get it,” Swanson said in a press release. “It's part of the problem of the fragmented, underfunded mental health system.”
Controversy Surrounding Kendra’s Law
The strongest argument against Kendra’s Law and other forced treatment laws is that patients do not have a say in whether or not they are treated, even with powerful psychiatric drugs.
This is one of many arguments psychiatrist John Grohol made in an article “The Double Standard of Forced Treatment.” He warned of historical examples in which the law has been used to unjustly hold people against their will in the name of forced treatment.
“Such forced treatment now requires a judge’s signature. But over time, that judicial oversight—which is supposed to be the check in our checks-and-balance system—has largely become a rubber stamp to whatever the doctor thinks is best,” Grohol wrote. “The patient’s voice once again threatens to become silenced, now under the guise of ‘assisted outpatient treatment’ (just a modern, different term for forced treatment).”
Kendra’s Law was intended to reduce violent acts by people who sought treatment for mental illness but failed to comply with it over time. However, researchers say that’s not the goal of the services mandated by some judges.
“Outpatient commitment is not designed to reduce the risk of violence; rather, it's designed to make sure someone who has been in and out of a psychiatric hospital a number of times gets treatment that can help them,” Swanson said. “At the same time, the laws that create these programs are often passed in response to a violent incident involving a person with mental illness.”