Understanding AOT

New York State has engaged legislation that provides for court-ordered assisted outpatient treatment (AOT) for certain people with mental illness who, in view of their treatment history, are unlikely to survive safely in the community without supervision.  The following questions and answers will help explain this new legislation, commonly referred to as "Kendra's Law."


Who may be affected by Kendra's Law?

A person may be ordered to obtain AOT if the court finds that he or she is at least 18 years of age and suffers from a mental illness; and is unlikely to survive in the community without supervision, based on clinical determination; and has a history of non-compliance with treatment for mental illness which has led to either 2 hospitalizations for mental illness in the preceding 3 years, or resulted in at least 1 act of violence toward self or others, or threats of serious physical harm to self or others, within the preceding 4 years; and is unlikely to accept the treatment recommended in a treatment plan; and is in need of AOT to avoid a relapse or deterioration that would likely result in serious harm to self or others; and will likely benefit from AOT.  Before a court may order AOT, it must be satisfied that AOT is the least restrictive alternative for the person.  Thus, if a less restrictive program or treatment exists that could effectively deal with the person's mental illness, the court will not issue an order for assisted outpatient treatment.

Whom should I contact if I think someone needs assistance through AOT?

Contact your county mental health director.  He/she is responsible for operating the county's AOT program, and can help you determine if the person meets the criteria for AOT.  He/she may also be aware of other available services if AOT is not appropriate for the individual.

What is the process to get AOT for someone?

The first step is filing a petition with the county court or supreme court for the county where the person resides or is believed to reside.  People authorized to file petitions for AOT are: a parent, spouse, adult sibling or adult child of the person; an adult roommate; the director of a hospital in which the person is hospitalized; the director of an organization, agency or home in which the person resides and receives services; a psychiatrist who is either treating or supervising the person's treatment; the social services official or mental health director for the county where the person is believed to be present; a parole or probation officer assigned to supervise the person.

What specifically needs to be filed with the court to begin the process?

The petition, which is a formal statement of facts demonstrating that the person meets the criteria for AOT, must be accompanied by the affidavit of an examining physician.  The affidavit must show that the physician examined the person within 10 days of the filing of the petition, and that he or she meets the criteria for AOT.  Several other procedural forms must also be filed, and standard fees must be paid at the time of filing.  All necessary forms are available through your county mental health department.

Does anything else need to be done?

Once the petition is filed with the court, copies must be served on: the person who is the subject of the petition; Mental Hygiene Legal Service; any health care agent appointed by the person in a health care proxy, if known; the Program Coordinator appointed by the New York State Office of Mental Health to oversee local AOT programs; and the appropriate county mental health director.

What happens next?

The court is required to set a hearing date that is no more than 3 days after the court receives the petition. (The hearing may be adjourned to a later date if the court finds good cause for doing so.)  At the hearing, the court will hear testimony of the physician whose affidavit was filed with the petition, and may also consider testimony of the petitioner and the subject of the petition.  Other forms of admissible evidence may be considered as well.  If the court determines that the criteria for AOT are met, and a written treatment plan has been filed with the court, an order for assisted outpatient treatment is issued.

To whom is the court order directed?

The court order is directed to both the person receiving AOT and the local director of the AOT program.  The order will require the person to accept the treatment deemed necessary by the court, and will require the local director to furnish such treatment.

How long does the person remain in the AOT program?

The initial court order is effective for up to 6 months from the date of the order.  The order can be extended for successive periods of up to 1 year each, but any application to extend AOT requires a showing that the person continues to meet all of the AOT criteria.

What happens if the person does not comply with the terms of the court order?

If a physician determines that the person may need involuntary admission to a hospital, the physician may recommend that the person be transported to a hospital and retained for up to 72 hours to determine if inpatient care and treatment are necessary.  Any refusal of the person to take prescribed medication, or the failure of a test to determine either medication compliance or alcohol or drug use, may be considered by the physician in reaching the clinical determination regarding involuntary admission.  Any decision to retain the person beyond the initial 72 hours must be in accordance with the procedures for involuntary admission set forth in Mental Hygiene Law.

Whom do I contact if I have additional questions about assisted outpatient treatment?

Contact your county mental health director for further information.