Many New Yorkers agree the city needs to do more to help people with serious mental illness who can be seen roaming the streets and subways.
But on Wednesday, a day after Mayor Eric Adams announced an aggressive plan to involuntarily hospitalize those deemed too ill to care for themselves, experts in mental illness, homelessness and police expressed concern. skepticism that the plan could effectively solve a crisis that has baffled city leaders for decades.
Mr. Adams said he was ordering police and other city employees to take people to hospitals who posed a danger to themselves, even if they posed no risk of harm to others, placing the city at the center of a national debate on how to care for people with serious mental disorders.
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’ predecessor Bill de Blasio, has suggested the solutions to the current crisis lie beyond Mr Adams’ plan.
“Homelessness is driven by the rent-income gap and lack of affordable housing, and mental health issues for housed and unhoused people are driven by the lack of community mental health services,” said he said in a statement.
He added that city, state and federal governments “must all do more to address these interrelated crises so that New Yorkers see a difference on the streets, on public transit and in the census.” shelters”.
The mayor’s plan comes at the end of a year in which random attacks on subways and streets, many attributed to mentally ill homeless people, have left many New Yorkers on edge. Both Mr. Adams and Gov. Kathy Hochul have implemented numerous programs to address the problem, including adding outreach teams and cleaning up encampments, to try to convince people to move to shelters.
Mr Adams said people with mental illness were largely responsible for the rise in crime on the Tube, although most crimes overall were not committed by people who were homeless or had mental illness. mental illness, and that most people with mental illness or homelessness are not violent.
Jody Rudin, a former deputy city commissioner of homeless services who is now CEO of the Institute for Community Living, which runs housing and mental health programs under contract with the city, applauded the mayor for “being looked into this issue and talked about it”.
“There seems to be an appreciation for the need for community and trauma-informed services, not just lip service, and to some extent he puts his money where his mouth is,” she said.
But Ms Rudin said many of the people most in need of help are already well known to clinicians doing street outreach. And she said she feared those people would not be consulted by either the police, or emergency service workers, or hospital staff, who the mayor said would set up a new hotline, to decide on to bring someone to the hospital against their will.
“If done in a coordinated way, it could be really helpful for people’s ability to live healthy and fulfilling lives,” she said. “If it’s done in a haphazard and uncoordinated way, we have real concerns.”
William J. Bratton, the former New York City police commissioner, said Mr Adams was trying to do the right thing, but his plan would be very difficult to implement.
“There’s no room to put a lot of these poor souls,” he said. “This is a well-intentioned and long-overdue step to try to deal with this seemingly intractable problem in a more humane way.”
Mr. Adams acknowledged that New York does not have enough psychiatric beds to accommodate everyone and said the city will begin training police officers to respond with compassion.
After a decades-long campaign of deinstitutionalization that closed thousands of mental hospital beds and the loss of more beds during the pandemic, the city finds itself with a chronic shortage of beds. Hospitals are under constant pressure to make room for new psychiatric emergency patients.
Even if sufficient 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 sent to specialized shelters for people with mental illness. Some of these shelters are struggling to keep their residents out of harm’s way.
Experts say the best place to place someone with serious mental illness after discharge from hospital is usually supportive housing, which includes on-site social services, and has the best track record for keeping people long-term stable. But although the city and state are accelerating plans to create more supportive housing, they are so scarce that four out of five qualified applicants are turned down.
Simply finding outpatient psychiatric care providers, essential to breaking the cycle of hospitalization and jail that so many people with mental illness find themselves in, is difficult.
“Outpatient clinics are booked for months, if they even accept referrals,” said Bridgette Callaghan, who leads teams of clinicians on the ground who treat the most seriously mentally ill on the streets and in shelters for the Institute. for Community Living as part of a municipal 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 country would be watching New York’s approach. It will take months to properly train police on how to conduct psychological assessments and handle people who resist transport to hospitals, he noted.
“The cops are going to see this as another burden placed on them,” he said.
New Yorkers should not expect to see dramatic changes overnight. The city began training doctors who work with patients on the new guidelines on Tuesday. It will begin training police and emergency medical services personnel in the coming weeks, city officials said.
Mr. Adams acknowledged on Tuesday that the city would need significantly more psychiatric beds in hospitals for his plan to succeed, and he said he would work with Albany state lawmakers to add more beds. Ms. Hochul, who said she supported 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 faced 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 due to 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 said the plan violated people’s rights. They argue that the police should not be responsible for deciding who should be transported to hospitals.
“Instead of using the least restrictive approach, we default to an extreme that takes away basic human rights,” said Matt Kudish, executive director of the National Alliance on Mental Illness in New York.
Jumaane Williams, the city’s public attorney, and some other elected Democrats have raised concerns about police assessing people on the streets and the lack of details about the care people will receive once they are evicted. .
“It’s a major red flag right there,” Mr Williams said.
Mr Williams said that while he was happy that Mr Adams was committed to helping people with serious mental illness, he was concerned that black men would be disproportionately affected by the new policy and that people would be discharged from overcrowded hospitals. He said the city should focus on funding less intrusive programs like homeless shelters, where people can get a hot meal and a shower, and urgent mental health care centers. .
“You have to put the funding into the programs that are needed so you don’t have to,” he said.
Ron Kim, a left-leaning Queens State Assemblyman, said he supports the plan because he thinks Mr Adams wants to rebuild government to help the public.
“He’s saying the buck stops here — he’s saying we’re going to get city workers to step in,” 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 pushed in front of a subway train by a homeless and mentally ill man.
“I was shocked to learn that because of the pain he was feeling, he was not focused on punishing the abuser,” Mr Kim said. “He was really pissed that we didn’t see the signs and we didn’t intervene.”
Thea Kvetenadze contributed report.
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