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In late November, New York City Mayor Eric Adams announced a controversial policy that would involuntarily hospitalize more people with mental illness. Adams called it a “moral imperative” to ensure vulnerable New Yorkers receive treatment. He said it gave people too much power to bind them, and that it was just a way to clear homeless people from the streets of the city.
Adams’ plan sets out the criteria for what justifies psychiatric hold, including those with mental illness who are unable to meet their basic needs, even if they are not an active threat to themselves or others. Former police chief Adams says state law allows for this interpretation. But attorneys for the Coalition of Civil Society have filed a motion to stop the policy, claiming it violates state mental health laws and the Americans with Disabilities Act. It’s part of an ongoing class action lawsuit over the city’s use of police officers to respond to crises.
Communities across the country are debating how to fix the broken mental health care system and what role involuntary treatment should play. Many politicians and news outlets equate homelessness with both mental illness, violence and crime. Research shows that most people with mental illness are not violent and are much more likely to be victims of crime than the general population.
Some groups are pushing for greater access to involuntary psychiatric care, which they say can save lives, especially for those who cannot get treatment because of their illness. This week, The New York Times ran a profile of his Tory, psychiatrist E. Fuller of the Center for Therapeutic Advocacy, one of the leaders of the movement.
However, disability rights groups argue that involuntary treatment violates the civil liberties of people with serious mental illness. Even temporary psychiatric restraint can be traumatic and discourage people from voluntarily seeking help in the future, advocates say. Instead, a robust community mental health her resource can prevent someone from falling into crisis.
Other communities are considering tactics similar to Adams. California Governor Gavin Newsom signed into law this fall mandating treatment for more people with schizophrenia and other disorders. Newsom called the legislation “a new hope for thousands of Californians.” The state’s Disability Rights Group said it would “uncover decades of progress for people with disabilities.”
According to The Oregonian, the same day Adams announced the plan, Portland, Oregon Mayor Ted Wheeler told business leaders to “re-evaluate current rules for involuntarily raping people with severe mental illness. supported,” he said.
There are pressing problems with such a proposal. One is the acute shortage of psychiatric hospital beds nationwide. Adams noted that New York Governor Kathy Hochul is creating 50 more psychiatric beds, but added: You can’t get around it. Critics also say that 50 beds are not enough for current needs.
New York City’s community mental health providers, who provide care after someone is discharged from the hospital, are also being stretched thin. Adams said patients should not be released unless he has follow-up services. But Crain’s New York found that as of mid-November, more than 1,000 New Yorkers were on waiting lists for mental health programs. Other hospital systems are under attack for “boarding” psychiatric patients into emergency rooms when there are no long-term care providers to take them.
In Adams’ plan, it is often the police who decide who to bring in for psychiatric evaluation. Encounters between officers and people in danger can easily escalate and lead to the use of force, criminal charges, or even death. A study by the Washington Post earlier this year found at least 178 cases nationwide between 2019 and 2021 where a “checkup” or mental health call ended in a fatal police shooting.
Data suggest that these policies are likely to disproportionately affect black and brown people. 44% of people currently receiving court-mandated treatment under one state law. And in Alameda County, California, which includes Oakland, black residents accounted for more than a third of involuntary psych holds, but only about 10% of the county population.
The battle over Adams’ policies continues. As one New York paramedic put it, “Our ambulances are just the gateway to a broken pipeline … if we want to avoid this ongoing tragedy, we need social services, housing, and mental health care. We have to invest a lot.”
