Newyork

New York’s Dilemma: Who Should Be Hospitalized Against Their Will?

Good morning. It’s Friday. Today we’ll take a closer look at one story — Mayor Eric Adams’s push to remove mentally ill people from streets and subways and involuntarily hospitalize them.

Credit…Gregg Vigliotti for The New York Times

This week Mayor Eric Adams issued a directive that calls for removing people with severe, untreated mental illnesses from streets and subways. He said this effort to address “a crisis we see all around us” would include involuntarily hospitalizing people who are a danger to themselves, even if they pose no threat to others. He said the city had a “moral obligation” to help them. I asked Andy Newman, who writes about society services and poverty in New York City, to explain what the mayor’s directive will mean.

In describing people he thought should not be on the streets, Adams mentioned one man who was mumbling and shadowboxing and another man who was standing across from a building he had been evicted from years ago. How does Adams intend for the police, emergency medical workers and others to determine that someone should be involuntarily hospitalized?

It’s not entirely clear. The state law on involuntary hospitalization empowers the police to have someone taken to the hospital only if the 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.”

A lawyer for the mayor said the grounds for hospitalization could include people who are a threat to themselves “by virtue of their inability to care for their basic needs, food, shelter, health care, those types of things.”

The lawyer, Brendan McGuire, said that people whom the police encounter in the street would have to be assessed “case by case.”

The police, along with emergency medical workers and some other responders, are going to be trained on how to do those assessments. They’ll be given a hotline to call, staffed by clinicians, to advise them on these decisions.

But a lot of advocates for people with mental illness note that involuntary hospitalization is usually traumatic and are worried about having the police do a lot of these evaluations. There is certainly a long history in the city of encounters between the police and emotionally disturbed people that ended badly when many observers thought they would not have if a social worker instead of a police officer had been sent to the scene.

How soon can New Yorkers expect to see fewer mentally ill homeless people on streets and in subways?

The mayor’s office says the effort will be rolled out gradually as the police, medics and field clinicians like social workers and nurses receive specialized training on assessing people’s mental health and making the call on whether someone needs to be hospitalized. The training for clinicians began on Tuesday. Training for the police and emergency medical services will begin in the coming weeks.

While Mayor Adams has acknowledged that there are not currently enough hospital psychiatric beds to hold the hundreds of people he said need to be hospitalized and that he would see that more beds are made available, he has not said how this would affect the timing of the program.

You write that when mentally ill people are discharged from hospitals, the best place for them to go is supportive housing, which provides on-site social services. It’s in short supply, too, isn’t it?

Yes, four qualified applicants for supportive housing get turned away for every one that gets an apartment. The city and state are both accelerating the creation of supportive housing, as well as the creation of “safe havens,” which are like shelters with fewer rules and restrictions and are often more appealing to people who live on the street because they’ve had bad experiences in barrackslike congregate shelters.

But there remains a severe shortage of good housing options for people with severe mental illness.

There are special shelters for people with mental illness, but an audit released by the state comptroller on Thursday found that the city had failed to place a quarter of homeless shelter residents with serious mental health issues in a mental-health shelter.

And something else about the mental-health shelters: A person who runs shelters told me that to the extent that the mayor’s plan is an attempt to halt the violent random attacks that have often set the city on edge in pandemic times, its focus on people who live on the streets and subways is misplaced, because a large number of those attacks are committed by people who already live in mental-health shelters and are still not getting all the help they need.

What about outpatient psychiatric treatment for those who have been hospitalized and released?

That also remains in short supply for this population, and it is crucial to keeping people from cycling back into hospitals, jails and the streets. Bridgette Callaghan, who runs street teams of clinicians under a city-funded program called Intensive Mobile Treatment, told me that outpatient clinics are booked for months out and that city-run field programs like hers have waiting lists.

Steven Banks, who ran homeless services under Adams’s predecessor, Bill de Blasio, and who spent decades suing the city on behalf of homeless people at the Legal Aid Society, has suggested that the solutions to the current crisis lay beyond Adams’s plan.

This push to remove mentally ill people comes through a directive the mayor issued, not a new law. This sets New York City apart from California, where Gov. Gavin Newsom recently signed a law that could force mentally ill homeless people into treatment. What are the legal obstacles Adams’s plan could face?

Norman Siegel, the former director of the New York Civil Liberties Union, is a sometime ally of Adams on homelessness policies. But he said that the Adams administration was trying to broaden and redefine the standard for involuntary hospitalization in a way that lacked legal authority and was inviting a court challenge.

If someone can be hospitalized when their mental illness prevents them from getting shelter, then by definition every mentally ill person sleeping on the streets or subways could be rounded up, he told me. And then he said this:

“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,” Siegel said. “And they’re going to have the cops, of all people, make those decisions?”

Will this plan change people’s perceptions that the subways are no longer safe?

Let’s talk about where those perceptions come from first. Riders’ perceptions that subways are unsafe are driven by two things: their own experiences of dealing with people on the platform or the train who seem unstable enough that they might lash out, and media reports about crime.

The statistics are not encouraging. Through October, felony assaults, murders and rapes in the subway system — all crimes that are likely to be random — were up 20 percent compared with the same period last year. Property crimes, including robberies, which can be violent, were up even more. This jump in crime has occurred despite several efforts by Mayor Adams to flood the transit system with police.


Weather

Enjoy another dry, sunny day, with temps steady near the high 40s. At night, prepare for increasing clouds, gustier winds and a chance of showers.

ALTERNATE-SIDE PARKING

In effect until Thursday (Immaculate Conception)


The latest New York news

Credit…Adrianna Newell for The New York Times
  • Contaminated cannabis: A medical cannabis trade group found contaminants such as E. coli and salmonella in some products purchased at unlicensed storefronts in New York.

  • Fatal shooting in the Bronx: A 14-year-old boy was found with a fatal gunshot wound outside an apartment building in the Bronx on Wednesday night, the police said.

  • Racial disparities in prisons: A new report documented significant racial and ethnic disparities in discipline across New York State prisons. Over a six-year period, Black inmates were 22 percent more likely to be disciplined than white ones.

  • What we’re watching: Sarah Maslin Nir, a Metro reporter, explains the city’s efforts to involuntarily remove people with severe, untreated mental illness from the city’s streets and subways on “The New York Times Close Up With Sam Roberts.” The show is broadcast on Friday at 8 p.m., Saturday at 1:30 p.m. and Sunday at 12:30 p.m. [CUNY TV]


METROPOLITAN diary

Bowie on the B

Dear Diary:

Dressing for a Saturday trip to Brooklyn Flea, I put on a navy turtleneck, a red Dickies jumpsuit, black sneakers and my David Bowie backpack.

I was on the B train when a woman got on wearing an outfit that was nearly the inverse of mine: red jacket, navy Dickies jumpsuit, white sneakers and David Bowie earrings. She noticed me as well, and we began to chat about music and its importance in our lives.

I couldn’t stop smiling all day to have found a new friend.

— Emily Easton

Illustrated by Agnes Lee. Send submissions here and read more Metropolitan Diary here.


Glad we could get together here. See you on Monday. — J.B.

P.S. Here’s today’s Mini Crossword and Spelling Bee. You can find all our puzzles here.

Melissa Guerrero, Morgan Malget and Ed Shanahan contributed to New York Today. You can reach the team at nytoday@nytimes.com.

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