Outpatient care for individuals with severe mental illnesses reduces crime

Researchers at the Mailman School of Public Health have determined that mandatory outpatient treatment for New Yorkers with severe mental illness leads to a drop in violent criminal behaviour. The study was published in the journal Psychiatric Services.

According to the researchers, the study is the first to fully assess the merits of Kendra’s Law, enacted in 1999, which mandates outpatient care for New Yorkers with psychotic disorders and other mental illnesses. Named after Kendra Webdale, who died after being pushed in front of a New York City subway train by a schizophrenic man who had skipped treatment, the temporary law is set to expire this summer. It has also become controversial; many critics question the method of forcibly coercing patients into treatment, fearing elevated stigma, decreased self-esteem and compromised civil freedoms.

More than 1,800 New Yorkers are currently enrolled in a court-ordered outpatient treatment program through Kendra's Law. According to Bruce Link, PhD, professor of epidemiology and sociomedical sciences at the Mailman School, director of the Center for Youth Violence Prevention, and lead investigator of the study, there are clear benefits to such involuntary care. "Our study has found that Kendra's Law has lowered risk of violent behaviours, reduced thoughts about suicide and enhanced capacity to function despite problems with mental illness."

The researchers studied patients in New York City clinics for the duration of a year between 2003 and 2006. They studied 76 mentally ill individuals ordered to undergo outpatient care due to histories of violence and non-compliant behaviour. The researchers then compared them with a control group of mentally ill outpatients enrolled in the same clinics, but placed into less intense treatment programs because they demonstrated fewer propensities toward violent behaviour and were more likely to follow through with treatment regimens.

According to the researchers, the individuals given mandatory outpatient treatment – who were more violent to begin with – were nevertheless four times less likely than members of the control group to perpetrate serious violence after undergoing treatment.

The researchers also noted that people who underwent mandatory treatment reported higher social functioning and slightly less stigma, rebutting claims that mandatory outpatient care is a threat to self-esteem.

"Outpatient commitment for people with mental illnesses is enormously controversial – it's been heralded as necessary and effective by some, and as overly coercive and counterproductive by others – but our study has found few of the negative consequences feared by critics of Kendra's Law," says Dr Link. However, the real take home message of the research, as Dr Link sees it, is that a policy that provides enhanced treatment for people with serious mental illnesses can improve their life circumstances and reduce the risk of violence.

At present, 42 states have laws mandating outpatient care for individuals with severe mental illnesses.

The Columbia University Mailman School of Public Health Columbia study, conducted in collaboration with the University of Michigan and the New York State Psychiatric Institute, was funded by the New York State Office of Mental Health.

(Source: Columbia University Mailman School of Public Health: Psychiatric Services: March 2010)