New York State Legislature ordered a comprehensive independent study of Kendra’s Law in 2022. The results have now been published and are being misrepresented.
My assumption is that there would be pretty major differences in the types of patients comprising the AOT and voluntary groups, but in the opposite direction from what the report indicates! Much demographic data suggests that the AOT individuals at baseline are probably more functional (and perhaps less ill?) than the voluntary cohort. Any thoughts as to why this is? I could imagine, for example, better resourced families pushing harder for AOT, or clinicians/judges looking at a younger, healthier individual and thinking that there is more reason to try and prevent further deterioration by being more aggressive.
While I find the functional outcomes dismal, I am somewhat impressed by the rather large reductions in risk of harm to self and others. Reducing the rate of physical violence in the AOT group from 30% to 9% is pretty significant.
My takeaway from the study is that AOT and voluntary treatment are practically the same in most major outcomes, which brings me to my next question. Are all individuals in the AOT group given the ability to opt-in to voluntary treatment? If no, then I think that obviously needs to change given the lack of clear practical differences between outcomes. If yes, then I think the question is whether or not we find the outcomes to be worth forcing people into AOT who would not otherwise voluntarily participate. I am skeptical of that for many reasons, but would also like to see if there are particular sub-populations that seem to respond particularly well to AOT.
Also adding that there are absolutely ppl who credit AOT qua court mandate with saving their lives — and I’ve heard the same for survivors of suicide attempts, jail and prison sentences, and the like, often similar to AA “hitting rock bottom” turning points. That’s a reality of life (and the complexities of life) that we all have to reckon with… And I’m skeptical that even the most careful subgroup analyses will ever allow us to predict in advance who will benefit on the whole and who will be harmed on the whole…
The comparisons are tricky because of the propensity score matching and done of this could just be an artifact (ie true for matched sample but not ACT in general). In terms of voluntary diversion — no, the largest counties in NY don’t support or allow it at all, though as I note the data from California and a bit more anecdotally from NY county leadership who do systematically pursue pre-AOT diversion is that an awful lot of AOT could be avoided. A further issue is that once AOT gets viewed as a service prioritization pathway, a lot of people are going to pursue it simply to get services. We had a heartbreaking conversation with a young couple in NY about this — boyfriend on AOT, girlfriend doing everything she could to “get on AOT” to access the same services, desperately needed. Didn’t matter one way or the other what legal status was involved — just a gateway to services. Meanwhile a senior county medical director told us that in their county individuals moved off AOT would immediately lose ACT access and so they’d keep them on orders, sometimes indefinitely, just to maintain (desperately needed) service access…
" with attorneys in the sample describing judges who simply deferred to the judge, "
Is this a TYPO?
Ugh yes, should be psychiatrist!
I’ll fix it
Thanks for the overview, Nev.
My assumption is that there would be pretty major differences in the types of patients comprising the AOT and voluntary groups, but in the opposite direction from what the report indicates! Much demographic data suggests that the AOT individuals at baseline are probably more functional (and perhaps less ill?) than the voluntary cohort. Any thoughts as to why this is? I could imagine, for example, better resourced families pushing harder for AOT, or clinicians/judges looking at a younger, healthier individual and thinking that there is more reason to try and prevent further deterioration by being more aggressive.
While I find the functional outcomes dismal, I am somewhat impressed by the rather large reductions in risk of harm to self and others. Reducing the rate of physical violence in the AOT group from 30% to 9% is pretty significant.
My takeaway from the study is that AOT and voluntary treatment are practically the same in most major outcomes, which brings me to my next question. Are all individuals in the AOT group given the ability to opt-in to voluntary treatment? If no, then I think that obviously needs to change given the lack of clear practical differences between outcomes. If yes, then I think the question is whether or not we find the outcomes to be worth forcing people into AOT who would not otherwise voluntarily participate. I am skeptical of that for many reasons, but would also like to see if there are particular sub-populations that seem to respond particularly well to AOT.
Also adding that there are absolutely ppl who credit AOT qua court mandate with saving their lives — and I’ve heard the same for survivors of suicide attempts, jail and prison sentences, and the like, often similar to AA “hitting rock bottom” turning points. That’s a reality of life (and the complexities of life) that we all have to reckon with… And I’m skeptical that even the most careful subgroup analyses will ever allow us to predict in advance who will benefit on the whole and who will be harmed on the whole…
The comparisons are tricky because of the propensity score matching and done of this could just be an artifact (ie true for matched sample but not ACT in general). In terms of voluntary diversion — no, the largest counties in NY don’t support or allow it at all, though as I note the data from California and a bit more anecdotally from NY county leadership who do systematically pursue pre-AOT diversion is that an awful lot of AOT could be avoided. A further issue is that once AOT gets viewed as a service prioritization pathway, a lot of people are going to pursue it simply to get services. We had a heartbreaking conversation with a young couple in NY about this — boyfriend on AOT, girlfriend doing everything she could to “get on AOT” to access the same services, desperately needed. Didn’t matter one way or the other what legal status was involved — just a gateway to services. Meanwhile a senior county medical director told us that in their county individuals moved off AOT would immediately lose ACT access and so they’d keep them on orders, sometimes indefinitely, just to maintain (desperately needed) service access…