Get Clarity On The Involuntary Treatment Laws In New York

What you will learn

• New York’s Mental Hygiene Law creates a legal framework to give mentally ill people treatment options without infringing on their rights.
• An update to Article 9 of the Mental Hygiene Law expands the capabilities of first responders to detain people exhibiting harmful behaviors for treatment involuntarily.
• The Mental Hygiene Law includes assisted outpatient treatment (AOP), or Kendra’s Law, for outpatient treatment detention.
• First responders and mental health professionals must meet stringent guidelines for involuntary treatment holds.

On November 29, 2022, Mayor Eric Adams issued a directive expanding the interpretation of New York State’s Mental Hygiene Law.[1] The existing law gave police officers, peace officers, mobile crisis outreach teams, and medical professionals the authority to enter an individual into involuntary treatment for mental health conditions.

The new directive expands the authority of first responders and allows for broader interpretation. Instead of involuntary admission based on violent or dangerous behaviors that can cause harm to themselves or others, individuals can be involuntarily admitted if they display an inability to meet their basic living needs.

What Is the Mental Hygiene Law in New York?

New York State passed the Mental Hygiene Law in 1972 to create a broad legal framework that addresses the needs and rights of the mentally disabled and incapacitated, allowing them to receive treatment while recognizing their right to make their own decisions.

This law outlines when an individual with severe mental illness may be admitted to a hospital for treatment. The situations include:[2]

• Voluntary rehab admission: If a person is seeking treatment for a mental illness, they may apply for admission to a hospital of their own volition to be evaluated. They can leave when they choose, even against medical advice, with the proper paperwork.
• Informal admission: Like voluntary admission, a person with a mental illness can request treatment at a hospital orally and receive an evaluation. If they meet the standard for informal admission, they can undergo treatment and may leave whenever they choose.
• Involuntary admission: There are two types of involuntary admissions processes. An individual may be admitted if their mental illness incapacitates them, threatens their well-being, or makes them a danger to themselves or others. The criteria for involuntary admissions are more complex than voluntary or informal admissions.

Expanded Article 9 Directive for Involuntary Admission

Under this new Article 9 directive, the hospital or institution may only keep the individual for 48 hours unless the first physician’s finding is confirmed by a second physician. The hospital or facility is also required to provide the individual with a notice detailing their rights to request a hearing within five days. If a determination isn’t reached within 15 days of admission, they may be discharged.

Under Article 9 of the Mental Hygiene Law, if further involuntary care and treatment are necessary, two physicians must certify that the person must be admitted. There are additional provisions for notice, hearing, review, and judicial approval. The individual can’t be retained for more than 60 days without approval.

Involuntary admission can take place in one of three ways:[3]

Medical Certification

This requires that two physicians examine a person and certify that they need involuntary care and treatment for mental illness. Informally, this is known as “two p.c.,” which means that “two physicians certify.” This also requires an application for admission from someone close to the individual, such as a next of kin, a treating psychiatrist, or a legal guardian. Failing that, a number of government officials can complete the application.

Certification by a Director of Community Services or an Examining Physician Designated by the Director of Community Services

This certificate says that the individual has a mental illness that can cause serious harm to themselves or others and requires immediate inpatient care and treatment. Individuals admitted this way must be examined within 72 hours by a staff psychiatrist. If they confirm that the requirements for involuntary admission have been met, the individual may be kept in the psychiatric center for up to 60 days.

Emergency Admission Based on the Claim of Mental Illness and Risk of Harm

An individual may be admitted if there’s a claim that they have a serious mental illness that can result in serious harm to themselves or others and require immediate observation, care, and treatment in a psychiatric center. Individuals admitted this way must be examined within 48 hours by a staff psychiatrist.

If the requirements for emergency admission have been met, they may be kept in the psychiatric center for up to 15 days. Beyond 15 days, they must meet the requirements for involuntary admission based on medical certification.

Kendra’s Law

Kendra’s Law, which has been in effect since November 1999, is a New York State law governing involuntary outpatient admission or assisted outpatient treatment (AOP). This law grants judges the authority to issue orders that require people to undergo psychiatric treatment if they meet certain criteria. If they fail to comply, they could be committed for up to 72 hours.

The criteria for Kendra’s Law must include clear and convincing evidence that:[4]

• The patient is 18 years of age or older,
• The patient is suffering from a mental illness,
• The patient is unlikely to survive in the community without supervision – as determined by a medical professional,
• The patient has a history of poor treatment compliance with previous hospitalization or admission and previous acts of violent behavior toward themselves or others within the prior four years,
• The patient is unlikely to participate in the recommended treatment voluntarily due to their mental illness,
• Considering the patient’s treatment history and current behavior, they are in need of AOP to prevent a relapse or deterioration that could result in serious harm,
• The patient is likely to benefit from an AOP program,
• If the patient has a health care proxy, all directions must be taken into account for the treatment program,
• The treatment plan must be the least restrictive that’s still likely to offer benefits to the patient.

With AOP, the person can only be ordered to attend treatment for a 12-month period maximum. At that time, continued AOP must be renewed by a petition filed prior to the expiration.

Originally proposed by the members of the National Alliance on Mental Illness and the Alliance on Mental Illness of New York State, Kendra’s Law is intended to help people get psychiatric help before they become a danger to themselves or others. Because outpatient care is less expensive and less restrictive, it was chosen as an alternative to inpatient admission.

Research into the efficacy of Kendra’s Law and AOP are mixed. According to a systematic review of the existing literature from Cochrane, patients who received involuntary treatment showed no significant difference in their quality of life, social functioning, or use of mental health services compared to voluntary treatment.[5] However, the review did report that people who receive involuntary treatment were less likely to be victims of crime.

What Happens After Involuntary Treatment in New York?

In some cases, the court may mandate AOP for people who have been discharged from involuntary admission to continue treatment. This often takes place in a long-term outpatient treatment facility, rather than a traditional hospital setting, with licensed and experienced mental health and medical professionals.

Get Help for Mental Health Today

The update to New York’s Mental Hygiene Law gives first responders more authority and interpretation for individuals struggling with mental illness, ensuring that people have access to treatment and care. However, involuntary treatment and the involvement of court hearings can create a daunting process that can hinder the success of treatment programs.

Don’t wait for a crisis to strike. Take a proactive approach for yourself or a loved one to seek help for mental health.

Amanda is a prolific medical content writer specializing in eating disorders and addiction treatment. She graduated Magna Cum Laude from Purdue University with a B.S. in Social Work. Read more