When a Relative With Schizophrenia Refuses Treatment in New York

Creator: Ryan S. Sultan, MD
Published: 2026-11-12

By Ryan S. Sultan, MD
Psychiatrist · Columbia University Irving Medical Center
Published November 12, 2026 · 9-minute read

Between 50% and 80% of people diagnosed with schizophrenia have been shown to lack insight, partially or totally, into having a mental disorder, according to a systematic review of 88 studies.¹ A second review put the range at 57 to 98 percent.² This lack of insight is also called anosognosia.

New York's formal routes include an emergency admission decided by a hospital physician and a court petition for assisted outpatient treatment under Kendra's Law. Each standard is quoted below from the State Senate's text of Mental Hygiene Law §§ 9.39 and 9.60, most recent revision dated August 8, 2025. This is general information from a psychiatrist and is not legal advice, and the statutes change.

Lack of insight is common, and it's linked to stopping medication

In a systematic review of reasons for stopping antipsychotic medication, poor insight was identified in 55.6% (20 of 36) of studies, more than any other reason.³ The sources gathered for this page on November 12, 2026 include no trial showing that a particular way of talking with a relative increases acceptance of treatment. I've written separately about long-acting injectable antipsychotics.

Family intervention is associated with fewer relapses in trials

A Cochrane review of 53 randomized trials concluded that family intervention may decrease the frequency of relapse (32 trials, 2,981 participants; risk ratio 0.55; 95% CI, 0.5 to 0.6), with the caution that poor trial quality may have led to overestimates.⁴ In a 2022 network meta-analysis of 90 randomized trials, every family model except crisis-oriented interventions and psychoeducation of two sessions or fewer reduced relapse at 12 months compared with treatment as usual.⁵

Who can petition under Kendra's Law

Under Mental Hygiene Law § 9.60(e)(1), a petition for assisted outpatient treatment is filed in the supreme or county court. The subdivision states: "Such petition may be initiated only by the following persons:"⁶

(i) any person eighteen years of age or older with whom the subject of the petition resides; or
(ii) the parent, spouse, domestic partner, sibling eighteen years of age or older, or child eighteen years of age or older of the subject of the petition; or
(iii) the director of a hospital in which the subject of the petition is hospitalized; or
(iv) the director of any public or charitable organization, agency or home providing mental health services to the subject of the petition or in whose institution the subject of the petition resides; or
(v) a qualified psychiatrist who is either supervising the treatment of or treating the subject of the petition for a mental illness; or
(vi) a psychologist, licensed pursuant to article one hundred fifty-three of the education law, or a social worker, licensed pursuant to article one hundred fifty-four of the education law, who is treating the subject of the petition for a mental illness; or
(vii) the director of community services, or his or her designee, or the social services official, as defined in the social services law, of the city or county in which the subject of the petition is present or reasonably believed to be present; or
(viii) a parole officer or probation officer assigned to supervise the subject of the petition.

Under subdivision (e)(3), the petition must be accompanied by an affirmation or affidavit of a physician, "who shall not be the petitioner". Section 9.60 carries the note "NB Repealed June 30, 2027".⁶

The criteria for assisted outpatient treatment in New York

Subdivision (c) of § 9.60 reads: "A person may be ordered to receive assisted outpatient treatment if the court finds that such person:"⁶

(1) is eighteen years of age or older; and
(2) is suffering from a mental illness; and
(3) is unlikely to survive safely in the community without supervision, based on a clinical determination; and
(4) has a history of lack of compliance with treatment for mental illness that has:
- (i) except as otherwise provided in subparagraph (iii) of this paragraph, prior to the filing of the petition, at least twice within the last thirty-six months been a significant factor in necessitating hospitalization in a hospital, or receipt of services in a forensic or other mental health unit of a correctional facility or a local correctional facility, not including any current period, or period ending within the last six months, during which the person was or is hospitalized or incarcerated; or
- (ii) except as otherwise provided in subparagraph (iii) of this paragraph, prior to the filing of the petition, resulted in one or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the last forty-eight months, not including any current period, or period ending within the last six months, in which the person was or is hospitalized or incarcerated; or
- (iii) notwithstanding subparagraphs (i) and (ii) of this paragraph, resulted in the issuance of a court order for assisted outpatient treatment that has expired within the last six months, and since the expiration of the order; (a) the person has experienced a substantial increase in symptoms of mental illness that substantially interferes with or limits the person's ability to comply with recommended treatment; or (b) the person, due to a lack of compliance with recommended treatment, has undergone emergency observation, care, and treatment or has been admitted for inpatient care or has been incarcerated;
(5) is, as a result of his or her mental illness, unlikely to voluntarily participate in outpatient treatment that would enable him or her to live safely in the community; and
(6) in view of his or her treatment history and current behavior, is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in serious harm to the person or others as defined in section 9.01 of this article; and
(7) is likely to benefit from assisted outpatient treatment. Previous non-compliance with court oversight or mandated treatment shall not preclude a finding that the person is likely to benefit from assisted outpatient treatment.

Under subdivision (j)(2), the court must find these "by clear and convincing evidence", along with "no appropriate and feasible less restrictive alternative", and the initial order is "not to exceed one year". Subdivision (g) gives the person the right to counsel at all stages.⁶

Whether a court can order antipsychotic medication

Section 9.60(j)(4) states: "A court may order the patient to self-administer psychotropic drugs or accept the administration of such drugs by authorized personnel as part of an assisted outpatient treatment program." Subdivision (n) states: "Failure to comply with an order of assisted outpatient treatment shall not be grounds for involuntary civil commitment or a finding of contempt of court."⁶

Emergency admission in New York

Under § 9.39(a), an approved hospital may receive and retain for fifteen days a person "alleged to have a mental illness for which immediate observation, care, and treatment in a hospital is appropriate and which is likely to result in serious harm to themself or others."⁷ The statute was amended on May 9, 2025, effective August 7, 2025, to codify an inability to meet essential needs as a basis for admission.⁸ It defines "Likelihood to result in serious harm" to mean:⁷

1. substantial risk of physical harm to themself as manifested by threats of or attempts at suicide or serious bodily harm or other conduct demonstrating that they are dangerous to themself, or
2. a substantial risk of physical harm to other persons as manifested by homicidal or other violent behavior by which others are placed in reasonable fear of serious physical harm, or
3. a substantial risk of physical harm to the person due to an inability or refusal, as a result of their mental illness, to provide for their own essential needs such as food, clothing, necessary medical care, personal safety, or shelter.

Admission requires that a staff physician of the hospital examine the person and find the requirements met, and retention beyond forty-eight hours requires confirmation by another physician from the psychiatric staff.⁷

Does Kendra's Law work? The evidence points both ways

In Medicaid claims and state reports for 3,576 people on court orders in New York, the likelihood of psychiatric hospital admission was about 25% lower during the initial six-month order than before it (odds ratio 0.77; 95% CI, 0.72 to 0.82).¹⁰ That is a pre/post comparison within the same people.

The randomized evidence differs. A Cochrane review of three trials (749 people) found no significant difference between compulsory and voluntary outpatient treatment in readmission by 11 to 12 months (2 trials, 416 people; risk ratio 0.98; 95% CI, 0.79 to 1.21; low-quality evidence).¹¹ A New York City pilot program established in 1994 at Bellevue Hospital randomized 142 people and found no statistically significant differences on major outcomes, with rehospitalization of 51 percent under court order and 42 percent with enhanced services alone.¹²

An independent evaluation submitted to the Office of Mental Health, dated September 2026, concluded that "positive outcomes are driven by access to needed services", naming several, "all of which are available voluntarily with comparable outcomes." Compared with a similar cohort in voluntary assertive community treatment, the court-order cohort did significantly better on four of 10 outcomes, the voluntary cohort did better on two, and four showed no significant difference.¹³

What a family can do now

For a medical emergency, call 911. The Office of Mental Health's crisis page also lists going to a psychiatric emergency program (CPEP) or to the emergency room at a local hospital.¹⁵
Speak with the treating team. A treating psychiatrist and the director of a hospital where the person is admitted are both on the list of people who may petition.⁶
Ask the team about family psychoeducation.^{4, 5}
Call, text or chat 988. The Office of Mental Health states: "You can also call, text or chat 988 if you are worried about someone you care about who may need crisis support." The line is free, confidential and available 24/7.¹⁴

State guidance says voluntary assessment and admission should be fully explored first, with involuntary routes used only when voluntary engagement isn't possible.⁹

Limitations of the evidence

This evidence has limitations. First, the statewide New York study is a pre/post comparison, and the Cochrane review found only three randomized trials and rated the readmission evidence low quality. Second, the insight figures are ranges from reviews, and the family-intervention abstracts don't report on relatives who refuse all contact with services. Nevertheless, the 2026 evaluation found that the services tied to better outcomes are also available voluntarily.

No legal route is certain to succeed, and each depends on findings made by a physician or a court. The first conversation belongs with the treating team.

Frequently asked questions

Who can file a Kendra's Law petition in New York?

Mental Hygiene Law § 9.60 limits petitioners to a listed group that includes any person eighteen or older with whom the person resides, and the parent, spouse, domestic partner, sibling eighteen or older, or child eighteen or older. Hospital directors, treating psychiatrists and certain other officials are also listed.⁶

Can you force someone to take antipsychotic medication in New York?

Section 9.60(j)(4) says a court may order a person in assisted outpatient treatment to self-administer psychotropic drugs or accept their administration by authorized personnel. The same section says failure to comply with an order is not grounds for involuntary civil commitment or a finding of contempt of court.⁶

What is the standard for emergency psychiatric admission in New York?

Section 9.39 requires a mental illness for which immediate hospital care is appropriate and which is likely to result in serious harm to the person or others. Amendments effective August 7, 2025 codified a third basis: a substantial risk of physical harm from an inability or refusal, as a result of mental illness, to provide for essential needs such as food, clothing, necessary medical care, personal safety, or shelter. A staff physician of the hospital must examine the person and find the requirements met.^{7, 8}

Does Kendra's Law actually work?

The evidence points both ways. In a New York pre/post study of 3,576 people, hospital admission was about 25% less likely during the first six-month order than before it, while a Cochrane review found no significant difference in readmission (2 randomized trials, 416 people; risk ratio 0.98). An independent evaluation submitted to the Office of Mental Health, dated September 2026, concluded that positive outcomes are driven by access to needed services that are available voluntarily with comparable outcomes.^{10, 11, 13}

Why does my relative with schizophrenia not think they are sick?

Lack of insight, also called anosognosia, is common in schizophrenia. Reviews put the proportion with partial or total lack of insight at 50% to 80%, and in another review at 57 to 98 percent.^{1, 2}

In a crisis: call or text 988, or go to the nearest emergency department. A first episode of psychosis belongs in a hospital-based or coordinated specialty care program.

I start and manage clozapine in an outpatient practice in Chelsea, Manhattan. Details are on the schizophrenia care in NYC page. Clozapine should not be stopped, skipped, or restarted without the prescriber. This page is general information and does not replace an evaluation.