NYC will forcibly hospitalize mentally ill people. Here’s what to know about the plan and its obstacles.

NYC will forcibly hospitalize mentally ill people. Here’s what to know about the plan and its obstacles.

Mayor Eric Adams is dramatically ramping up his strategy to address New York City’s homelessness and mental health crisis by directing police and emergency medical responders to force individuals deemed unable to meet “basic human needs” into hospitals.

Adams, a moderate Democrat who has prioritized public safety, described the plan as the “next phase” of an approach to homelessness that has included increased policing on the subways and the removal of homeless encampments.

An estimated 3,400 New Yorkers live on the streets and subways according to an annual city survey, although experts say the figure is a severe undercount. Although that number is down slightly from the pre-pandemic era, a string of high-profile deadly crimes committed by homeless people with reported histories of mental illness has rattled many New Yorkers.

But the city’s new plan is likely to face a host of legal and logistical challenges. Homeless and civil liberty advocates as well as some city lawmakers have already voiced their opposition to the policy.

Here’s what New Yorkers need to know about the new directive and the obstacles that lie ahead.

How does this policy different from the previous way the city handled mentally ill New Yorkers?

The mayor’s new directive essentially expands the definition of who qualifies for involuntary removal from public places for the sake of potential hospitalization. New York state’s Mental Hygiene Law outlines that a person can be taken to a hospital or psychiatric facility for an evaluation “if such person appears to be mentally ill and is conducting himself or herself in a manner which is likely to result in serious harm to the person or others.”

But City Hall officials are relying on a state health department memorandum issued in February that interprets the law as allowing “for the removal of a person who appears to be mentally ill and also displays an inability to meet basic living needs, even when no recent dangerous act has been observed.”

The memorandum also states that these guidelines are “intended to help clinicians and other community providers make thoughtful, clinically appropriate determinations relating to involuntary and emergency assessments.”

Speaking to reporters on Tuesday, Adams described behaviors that he said New Yorkers have become accustomed to seeing but warrant greater city intervention.

“You’re watching people standing there on the street talking to themselves, don’t have shoes on, shadowboxing, unkempt — and we are walking by them,” he said. “We are pretending as though we don’t see them.”

The mayor said he is refusing to “punt” the issue.

Who will be assessing whether an individual meets the criteria for involuntary hospitalization?

According to state law, a police officer, peace officer, physician or mental health professional can each make the assessment of whether to order someone to be involuntarily brought to a hospital.

On Tuesday, the mayor said that police and first responders have been reluctant to use their authority under the law “because there has not been any real clarity.”

Deputy Mayor for Health and Human Services Anne Williams-Isom on Tuesday told reporters that the decisions would be made on a “case-by-case” basis, but she outlined some of the process.

“You ask them questions, you ask them where have they been. You ask them do they have a place to go?” she said.

She added that an evaluation could take into account their physical well-being and whether they are “not based in reality.”

If police or first responders are unsure, she said they would be able to call on specialized teams that include mental health professionals. However, she could not immediately say how many city workers are currently dedicated to this helpline.

Once an individual is brought to a hospital, a medical doctor will determine whether they meet the criteria allowing them to be involuntarily committed, according to Brendan McGuire, the mayor’s chief legal counsel.

Does the city have enough beds and programs to treat the mentally ill?

No. Emergency room doctors have frequently complained about a shortage of so-called “psych beds.”

Following the mayor’s announcement on Tuesday, Dr. Craig Spencer, the former director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center, was among those in the medical community who expressed their concerns. Spencer now works for the Brown University School of Public Health.

In a tweet, he described the city’s mental health system as “dramatically understaffed and under-resourced,” with patients often waiting days or weeks for placement in the emergency room.

Other mental health facilities and programs have also been strained, according to Public Advocate Jumaane Williams, who recently issued an update to a 2019 report on the city’s response to the crisis.

The public advocate also found that since 2019 the number of respite care centers — mental health facilities that offer an alternative to hospitalization — fell by half. Meanwhile, the number of mobile crisis units — teams made up of social workers, nurses and psychiatrists — dropped from 24 to 19.

How have lawmakers and advocates responded to the plan?

Reception has been mixed.

On Wednesday, City Council Speaker Adrienne Adams issued a statement saying that she and her colleagues had “many questions” about the new policy and how it will be carried out.

“The vague and broad definitions surrounding mental illness, and the delegated authority to non-mental health professionals for involuntary removal and admission raise serious concerns,” she said. “The way this new policy will be implemented and the agencies and individuals being tasked with this response need to be more carefully considered, and the Council will continue playing a strong oversight role.”

She cautioned against “unduly relying on involuntary commitment and short-term responses that can be counterproductive.”

Tiffany Cabán, a left-leaning Queens councilmember and a former public defender, similarly criticized the use of involuntary hospitalization.

“Consent is key,” she tweeted.

But at least two other Queens councilmembers have publicly expressed support for the mayor’s directive.

The mayor has received key support from Gov. Kathy Hochul as well as a handful of state lawmakers. He will need the state Legislature’s backing for an 11-point series of reforms in state law that seek to provide clearer guidance on when involuntary hospitalizations can be ordered.

Hazel Crampton-Hays, a spokesperson for Hochul, issued a statement praising the mayor’s plan as one that “builds on our ongoing efforts together” around mental illness, including outreach teams in the subways and increasing bed capacity at psychiatric hospitals.

Among homeless advocates, Jacqueline Simone, policy director for Coalition for the Homeless, accused the mayor of having “continually scapegoated homeless people and others with mental illness as violent.”

Simone argued that instead of leaning on involuntary hospitalizations the mayor should instead focus his efforts on “expanding access to voluntary inpatient and outpatient psychiatric care.”

But the Legal Aid Society, which also represents the homeless, praised the mayor for taking a “step in the right” direction by addressing the city’s mental health crisis.

At the same time, Tina Luongo, Legal Aid’s chief attorney, told WNYC that “involuntary confinement, whether it’s in a hospital or a jail or prison, is not the answer that we need.”

The group is urging Adams to to support legislation that would allow New Yorkers who are charged with crimes and also have substance use disorders or mental health conditions to be placed in treatment programs as opposed to jail.

The stiffest criticism has come from civil liberty defenders.

Donna Lieberman, the executive director of the New York Civil Liberties Union, also decried the plan as “playing fast and loose with the legal rights of New Yorkers.”

She also cautioned about legal challenges that the new policy will prompt. “The federal and state constitutions impose strict limits on the government’s ability to detain people experiencing mental illness – limits that the mayor’s proposed expansion is likely to violate,” she said.

Similarly, Norman Siegel, a noted civil rights attorney and longtime adviser to the mayor, also said the plan was misguided and that the city was skating on thin legal ground.

Is this the first time the city has ever enacted such a policy?

No. In 1987, then-Mayor Ed Koch introduced a program that placed severely mentally ill people found on Manhattan streets into a psychiatric ward at Bellevue Hospital. But the policy was undermined by court battles, overcrowding and bureaucratic problems. It gave way to a landmark lawsuit involving a woman who was confined for 12 weeks. A state judge ruled that she should be freed because the city failed to prove she was mentally ill or unable to care for herself. But the decision was reversed by a state appeals court. Ultimately, psychiatrists decided to release her after Brown successfully convinced the court that she should not be forced to take medication.

Brown later became famous, speaking at Harvard University and being interviewed on “60 Minutes.” She eventually moved into a long-term residence for people with mental illness.

She died at age 58 on Nov. 29, 2005.

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