Audit Report on the Department of Health and Mental Hygiene’s Monitoring of the Local Assisted Outpatient Treatment Program


The objective of this audit was to determine whether the Department of Health and Mental Hygiene (DOHMH) is adequately monitoring the assisted outpatient treatment (AOT) program to ensure the proper administration of court-ordered mental health treatment plans.

In 1999, New York State enacted Kendra’s Law (New York Mental Hygiene Law § 9.60), named after Kendra Webdale, a young woman who died in January 1999 after being pushed in front of a New York City subway train by a person who had a long history of mental illness but who was not receiving treatment at the time of the incident.  The law provides for AOT for certain individuals who, in view of their treatment history and circumstances, are determined by the court to be unlikely to live safely in the community without supervision.

The AOT process is initiated when a correctional facility, a treatment facility, or a member of the community (which may include a family member, friend, or neighbor) refers an individual to the program.  DOHMH, through its Division of Mental Hygiene, is responsible for implementing the law in the five boroughs.

Upon the issuance of a court order, individuals accepted to the program (referred to as “consumers”) are required to follow the treatment plan promulgated by the court.  Responsibility for directly monitoring the consumers’ progress and for coordinating the mandated services rests with care coordinators employed by privately operated care providers pursuant to contracts with the City and State.  DOHMH AOT case monitors and private care coordinators are required to maintain communication with each other on a regular basis to ensure consumers are receiving all the mandated services.

DOHMH served 1,917 AOT consumers in Fiscal Year 2012 and 1,922 AOT consumers in Fiscal Year 2013.

Audit Findings and Conclusion

Because of the scope limitations resulting from restrictions to our access to certain confidential data as described later in this report, we were unable to obtain sufficient, appropriate evidence to determine whether DOHMH is adequately monitoring the local AOT program in order to ensure that court-ordered mental health treatment plans are being properly administered.  We observed that DOHMH has taken a proactive approach in identifying weaknesses in its program and has reportedly implemented control procedures to improve its administration of the program. Our limited testing indicates that these control procedures may have effectively addressed some program weaknesses.  However, the audit concluded that DOHMH did not track or follow up on the application forms sent to community referrers who inquired about the possible eligibility of individuals for the AOT program.  As a result, consumers who might benefit from the program may not have been considered for eligibility.

Audit Recommendation

To address the one issue identified, the audit recommends that DOHMH require logging, tracking, and follow-up on application forms sent to community members attempting to make a referral to AOT.

Agency Response

In its response, DOHMH agreed with our one recommendation, stating that it “will further explore the feasibility of tracking and following up on application forms sent to individuals in the community who have called to inquire about the program.”  However, DOHMH took issue with the scope limitation described in the report, specifically questioning “what the identification of the consumers would add to the auditing process, and exactly why all the data provided still left the auditors unable to reach a conclusion.”  It added that it provided the auditors with all the records maintained by AOT, except the data fields that identify the AOT consumers.

We disagree with DOHMH’s position regarding our scope limitation.  As we stated in the draft report, due to mental health record privacy concerns, we were limited as to the type of information we could independently retrieve and review.  Accordingly, we were unable to conduct certain independent observations and walkthroughs of the AOT process or obtain information directly from the contracted care providers and could only perform limited testing of sampled cases based on documents retrieved and redacted by agency personnel.  As a result, we did not have reasonable assurance that the information we received was reliable or complete, nor did we have sufficient, appropriate evidence to provide a reasonable basis for an overall conclusion regarding our audit objective.