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New York’s Plan to Address Crisis of Mentally Ill Faces High Hurdles

November 30, 2022

Many New Yorkers agree that the city must do more to help people with severe mental illness who can be seen wandering the streets and subways.

But on Wednesday, a day after Mayor Eric Adams announced an aggressive plan to involuntarily hospitalize people deemed too ill to care for themselves, experts in mental illness, homelessness and policing expressed skepticism that the plan could effectively solve a crisis that has confounded city leaders for decades.

Mr. Adams said he was instructing police officers and other city workers to take people to hospitals who were a danger to themselves, even if they posed no risk of harm to others, putting the city at the center of a national debate over how to care for people with severe mental illness.

Mental health experts and elected officials applauded the mayor’s attention to the issue, but also raised questions about how his plan would be implemented, how many people might be affected and whether police officers should be involved.

Steven Banks, the former social services commissioner under Mr. Adams’s predecessor, Bill de Blasio, suggested that the solutions to the current crisis lay beyond Mr. Adams’s plan.

“Homelessness is driven by the gap between rents and income and the lack of affordable housing, and mental health challenges for both housed and unhoused people are driven by the lack of enough community-based mental health services,” he said in a statement.

He added that the city, state and federal governments all “need to do more to address these interrelated crises in order for New Yorkers to see a difference on the streets, on public transportation, and in the shelter census.”

The mayor’s plan comes at the end of a year in which random attacks in the subways and streets, many of them attributed to homeless people with mental illness, have put many New Yorkers on edge. Mr. Adams and Gov. Kathy Hochul have both rolled out numerous programs to address the issue, including adding outreach teams and clearing encampments, to try to convince people to move to shelters.

Mr. Adams has said that people with mental illness were largely responsible for an increase in crime in the subway, though most crimes overall are not committed by people who are unhoused or mentally ill, and most mentally ill or homeless people are not violent.

Jody Rudin, a former deputy city commissioner of homeless services who is now C.E.O. of the Institute for Community Living, which runs housing and mental-health programs under contract with the city, applauded the mayor for “leaning into and talking about this issue.”

“There seems to be an appreciation for the need for trauma-informed and community-based services, not just lip service, and to some extent he’s putting his money where his mouth is,” she said.

But Ms. Rudin said that most of the people in greatest need of help are already well known to clinicians who do street outreach. And she said that she was concerned that those people would be consulted by neither police officers, emergency services workers, nor hospital personnel who the mayor said would staff a new hotline, in deciding whether to bring someone to a hospital against their will.

“If it’s done in a coordinated way, it could be really helpful to people’s ability to live healthy and fulfilling lives,” she said. “If it’s done in a messy and uncoordinated way, we have real concerns.”

William J. Bratton, the former New York City police commissioner, said that Mr. Adams was trying to do the right thing, but that his plan would be very difficult to carry out.

“There’s no place to put a lot of these poor souls,” he said. “It’s a well-intended measure and long overdue to try to deal in a more humane way with this seemingly intractable problem.”

Mr. Adams has acknowledged that New York did not have enough psychiatric beds to accommodate everyone, and said the city would start training police officers about responding with compassion.

After a decades-long deinstitutionalization push that closed thousands of psychiatric hospital beds, and the loss of more beds during the pandemic, the city finds itself with a chronic bed shortage. Hospitals are under constant pressure to make room for new psychiatric emergency patients.

Even if enough hospital capacity can be created to admit many more people, it is unclear what will happen when the hospital discharges someone.

Some people would be discharged to specialized shelters for people with mental illness. Some of those shelters have difficulty keeping their residents out of trouble.

Experts say the best place to put someone with severe mental illness after they leave a hospital is usually in supportive housing, which comes with on-site social services, and has the best track record for keeping people stable over the long haul. But though the city and state are accelerating plans to create more supportive housing, it is in such short supply that four of five qualified applicants are turned away.

Simply finding providers of outpatient psychiatric care, essential to breaking the cycle of hospitalization and jail that so many people with mental illness wind up in, is difficult.

“Outpatient clinics are booked for months out, if they even are taking referrals,” said Bridgette Callaghan, who runs teams of field clinicians that treat the most severely mentally ill people in streets and shelters for the Institute for Community Living under a city program called Intensive Mobile Treatment.

Mr. Bratton, who served as police commissioner under Mayor Rudolph W. Giuliani and Mr. de Blasio, said the plan was risky for Mr. Adams and that leaders across the nation would be watching New York’s approach. It will take months to properly train police officers about how to conduct psychological evaluations and how to handle people who resist being transported to hospitals, he noted.

“The cops are going to see this as another burden being placed on them,” he said.

New Yorkers should not expect to see dramatic changes overnight. The city started training doctors who work with patients about the new guidance on Tuesday. It will begin training police officers and Emergency Medical Services staff in the coming weeks, city officials said.

Mr. Adams acknowledged on Tuesday that the city would need many more psychiatric beds at hospitals for his plan to be successful, and he said that he would work with state lawmakers in Albany to add beds. Ms. Hochul, who has said she supports the mayor’s efforts, recently announced that the state was setting up two new units at psychiatric centers, including 50 inpatient beds.

Alanna Shea, 38, has dealt with homelessness, addiction, and mental illness, and said she is currently a “drop-in” at a shelter. She said she was alarmed by the new policy because of her own experiences in hospitals.

“It scares me,” she said, speaking near a subway entrance on 125th Street in Harlem. “I want to be safe here but I also want to be safe if I’m in a facility.”

Mental health advocates have said the plan infringes on people’s rights. They argue that police officers should not be responsible for deciding who should be transported to hospitals.

“Instead of using the least restrictive approach, we are defaulting to an extreme that takes away basic human rights,” said Matt Kudish, chief executive of the National Alliance on Mental Illness of New York City.

Jumaane Williams, the city’s public advocate, and some other Democratic elected officials have raised concerns about police officers evaluating people on the streets and the lack of details on what care people will receive once they are removed.

“That’s a major red flag right there,” Mr. Williams said.

Mr. Williams said that while he was glad that Mr. Adams was committed to helping people with severe mental illness, he worried that Black men would be disproportionately affected by the new policy and that people would be turned away from overburdened hospitals. He said that the city should focus on funding less intrusive programs like homeless drop-in centers, where people can get a hot meal and a shower, and mental health urgent care centers.

“You have to put the funding into the programs that are needed so you don’t have to do this,” he said.

Ron Kim, a left-leaning state assemblyman from Queens, said he was supportive of the plan because he believes that Mr. Adams wants to rebuild government to help the public.

“He’s saying the buck stops here — he’s saying we’re going to activate city workers to intervene,” Mr. Kim said.

Mr. Kim said he was moved by a recent dinner with the father of Michelle Go, who was killed in January when she was shoved in front of a subway train by a homeless and mentally ill man.

“I was shocked to hear that from the pain he’s been going through, he wasn’t focused on punishing the attacker,” Mr. Kim said. “He was really furious about how we didn’t see the signs, and we failed to intervene.”

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About Institute for Community Living

It is Institute for Community Living’s (ICL) mission to help New Yorkers with behavioral health challenges live healthy and fulfilling lives by providing comprehensive housing, health care, and recovery services. We take a trauma-informed approach—meeting the people we serve wherever they are, working together to support them in achieving their goals.

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