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New York City to involuntarily remove mentally ill people from streets

NEW YORK — 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 Tuesday to remove people with severe, untreated mental illness from the city’s streets and subways.

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,” Adams said in an address at City Hall. “This myth must be put to rest. Going forward, we will make every effort to assist those who are suffering from mental illness and whose illness is endangering them by preventing them from meeting their basic human needs.”

The mayor’s announcement comes at a heated moment in the national debate about rising crime and the role of police, especially in dealing with people who are already in fragile mental health. Republicans, as well as tough-on-crime Democrats like Adams, a former police captain, have argued that growing disorder calls for more aggressive measures. On the other side, 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.

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Other large cities have struggled with how to help homeless people, in particular those dealing with mental illness. In California, Governor 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.

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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 new policy immediately raised questions about who, exactly, would be swept up in it.

Existing state laws allow both the police and medical workers to authorize involuntary commitment of people whose behavior poses a threat of “serious harm” to themselves or others. Brendan McGuire, chief counsel to the mayor, said Tuesday that workers would assess people in public spaces on a “case by case” basis, including 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 lawmakers in Albany 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. Adams said the city would direct hospitals to keep those patients until they are stable and to discharge them only when there is a workable plan in place to connect them to ongoing care.

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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. He noted that Governor Kathy Hochul had agreed to add 50 new psychiatric beds. “We are going to find a bed for everyone,” Adams said

It is unclear how many people might be affected by the new policy. The number of homeless people with severe mental illness who are not living in shelters fluctuates seasonally but 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. An annual estimate that is often criticized as an undercount counted about 3,400 people living in streets and subways in January.

Since the pandemic, a series of high-profile random attacks in the streets and subways has left many New Yorkers feeling that the city has become more unpredictable and dangerous. Many of those charged in the attacks have been people struggling with both mental illness and homelessness, leading to demands from many quarters that elected officials take steps to address these problems.

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

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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.

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.

He added: “The very nature of their illnesses keeps them from realizing they need intervention and support. Without that intervention, they remain lost and isolated from society, tormented by delusions and disordered thinking.”

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Adams, a Democrat, 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.

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 Adams was over-reliant on policing.

The report found that the number of mental health crisis centers and mobile mental crisis response teams had fallen since 2019. It also found that police rather than behavioral health professionals were still the city’s main option in responding to mental health emergencies even though police officers were not receiving sufficient training, and that the mayor had cut funding to a program that dispatched mental health professionals, rather than police, to certain emergencies.

One advocate for mentally ill people said the measures announced by the mayor went too far and would prove counterproductive.

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