NYC Will Hospitalize Mentally Ill People Involuntarily

Health & Wellbeing

Acting to address “a crisis we see all around us” toward the end of a year that has seen a string of high-profile crimes involving homeless people, Mayor Eric Adams announced a major push on Tuesday to remove people with severe, untreated mental illness from the city’s streets and subways.

Mr. Adams, who has made clearing homeless encampments a priority since taking office in January, said the effort would require involuntarily hospitalizing people who were a danger to themselves, even if they posed no risk of harm to others, arguing the city had a “moral obligation” to help them.

“The common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent,” Mr. Adams said in an address at City Hall. “Going forward, we will make every effort to assist those who are suffering from mental illness.”

The mayor’s announcement comes at a heated moment in the national debate about rising crime and the role of the police, especially in dealing with people who are already in fragile mental health. Republicans, as well as tough-on-crime Democrats like Mr. Adams, a former police captain, have argued that growing disorder calls for more aggressive measures. Left-leaning advocates and officials who dominate New York politics say that deploying the police as auxiliary social workers may do more harm than good.

Other large cities have struggled with how to help homeless people, in particular those dealing with mental illness. In California, Gov. Gavin Newsom recently signed a law that could force some homeless people with disorders like schizophrenia into treatment. Many states have laws that allow for involuntary outpatient treatment, and Washington State allows people to be committed to hospitals if a judge finds that they pose a threat to themselves or others.

Officials in New York said the city would roll out training immediately to police officers, Emergency Medical Services staff and other medical personnel to “ensure compassionate care.” But the city’s new directive on the policy acknowledges that “case law does not provide extensive guidance regarding removals for mental health evaluations based on short interactions in the field.”

The policy immediately raised questions about who, exactly, would be swept up in it, and some advocates for people with mental illness warned it could face legal challenges.

Existing state laws allow both the police and medical workers to take people involuntarily to a hospital when their behavior poses a threat of “serious harm” to themselves or others. Brendan McGuire, chief counsel to the mayor, said on Tuesday that workers would assess people in public spaces “case by case” to see whether they were able to provide basic needs such as food, shelter and health care for themselves.

The city directive states that “unawareness or delusional misapprehension of surroundings” or “delusional misapprehension of physical condition or health” could be grounds for hospitalization.

The effort will also involve an increase in the use of Kendra’s Law, which lets courts mandate outpatient treatment for those who are a danger to themselves or others and which was expanded by Albany lawmakers in April.

Frequently, homeless people with severe mental illness are brought to hospitals, only to be discharged a few days later when their conditions improve slightly. Mr. Adams said the city would direct hospitals to keep those patients until they are stable and discharge them only when there is a workable plan in place to connect them to ongoing care.

Hospitals often cite a shortage of psychiatric beds as the reason for discharging patients, but the mayor said that the city would make sure there were enough beds for people who were removed from the street. He noted that Gov. Kathy Hochul had agreed to add 50 new psychiatric beds. “We are going to find a bed for everyone,” Mr. Adams said

The number of homeless people with severe mental illness who do not live in shelters is, at the very least, in the hundreds. According to the Coalition for the Homeless, an advocacy group, studies have shown that a large majority of unsheltered New Yorkers have mental illness or other severe health problems. About 3,400 people were living in streets and subways in January, according to an annual estimate that is often criticized as an undercount.

Since the pandemic, a series of random attacks in the streets and subways has left many New Yorkers feeling that the city has become more unpredictable and dangerous. .

Crime has increased sharply in the subways this year, and the mayor said last month, “When you do an analysis of the subway crimes, you are seeing that it’s being driven by people with mental health issues.”

In January, days after the mayor took office, a woman was pushed to her death in front of a subway train by a man who had schizophrenia and who had cycled in and out of the city’s hospitals, jails and streets for decades. The man, Martial Simon, became an emblem of a broken system and prompted hearings by the state’s attorney general and a scramble across the city’s public health and emergency response systems to tackle a problem that has seemed intractable.

Mr. Adams on Tuesday emphasized the importance of hospitalizing and treating people with severe mental illness even if they are not threatening anyone.

“The man standing all day on the street across from the building he was evicted from 25 years ago waiting to be let in; the shadow boxer on the street corner in Midtown, mumbling to himself as he jabs at an invisible adversary; the unresponsive man unable to get off the train at the end of the line without assistance from our mobile crisis team: These New Yorkers and hundreds of others like them are in urgent need of treatment and often refuse it when offered,” the mayor said.

While much of the mayor’s plan involves making heavier use of laws already in place, he said the city also needed Albany to address “longstanding gaps in our state mental health law.”

The city would like the state to require hospitals to coordinate on discharge planning with providers in the community and to consider someone’s history, not just their current state, in making admission decisions; to let social workers and other non-doctors evaluate patients for Kendra’s Law orders; and to broaden the standard for involuntary hospitalization. Gov. Hochul, in a statement, said the mayor’s plan would build on work the state and city were already doing.

Mr. Adams has received criticism from some progressive members of his party for clearing homeless encampments and for continuing to push for changes to bail reform that would make it easier to keep people in jail. The mayor has defended his focus on public safety and has argued that many New Yorkers do not feel safe, particularly in Black and Latino neighborhoods.

Mr. Adams held an event at a subway station on Monday to thank police officers who helped a homeless man who fell on to the tracks, an episode that he said “highlights why we have been focused on removing homelessness off our subway system.” He added: “The subway system is not a place for people who need medical and psychiatric assistance.”

Earlier this month, the city’s public advocate, Jumaane Williams, released a report criticizing the mayor’s efforts to help New Yorkers with serious mental illness, saying that some programs for them had shrunk and that Mr. Adams had been over-reliant on police.

On Tuesday, Mr. Williams, along with several public-defender organizations, including the Legal Aid Society, praised the mayor for bringing attention to the issue.

“Still,” Mr. Williams said, “the mayor’s announcement leaves many details unspecified, questions unanswered, and the administration must provide more information on the intentions, implementation, and non-police investment in its plan.”

Several advocates for people with mental illness said that the mayor’s plan went too far and would prove counterproductive.

“The mayor talked about a ‘trauma-informed approach,’ but coercion is itself traumatic,” said Harvey Rosenthal, chief executive of the New York Association of Psychiatric Rehabilitation Services and a longstanding critic of involuntary confinement.

He said that the mayor’s approach relied on “the same failed system that’s overburdened and can’t address the people they already have now.”

Norman Siegel, the former head of the New York Civil Liberties Union and co-founder of a volunteer outreach program, the Street Homeless Advocacy Project, that has been endorsed by the mayor, said that the mayor’s plan lacked legal authority. He predicted it would be challenged in court.

“Just because someone smells, because they haven’t had a shower for weeks, because they’re mumbling, because their clothes are disheveled, that doesn’t mean they’re a danger to themselves or others,” Mr. Siegel said. “And they’re going to have the cops, of all people, make those decisions?”

The Brooklyn Center for Independence of the Disabled, an advocacy group, said that involuntary hospitalization constituted “discrimination under the Americans with Disabilities Act.”

Mr. Adams warned that the new policy would take time to implement. “Nobody should think decades of dysfunction can be changed overnight,” he said.

City Councilwoman Tiffany Cabán said on Twitter on Tuesday that the mayor’s plan was “deeply problematic” and that consent was key in responding.

“Often the wrong responder & response is what creates a deadly situation, not the mental health crisis itself,” she said.

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