Mayor Eric Adams announced a major effort on Tuesday to remove people with severe, untreated mental illness from the city’s streets and subways, saying New York had “a moral obligation” to address “a crisis we see all around us.”
The effort will involve hospitalizing people involuntarily, even if they do not pose an immediate risk of harm to others.
“The common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent,” Mr. Adams said. “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 city said it 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.”
Frequently, homeless people with severe mental illness are brought to hospitals, only to be discharged a few days later when their conditions improve slightly. Mr. 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.
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 are removed. He noted that Gov. Kathy Hochul had agreed to add 50 new psychiatric beds. “We are going to find a bed for everyone,” Mr. Adams said.
Asked about the legality of holding people involuntarily, Brendan McGuire, chief counsel to the mayor, said on Tuesday that people would be held under a state mental hygiene law that allows for involuntary commitment if they are a threat to themselves or others. Mr. McGuire said that workers would assess people 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 effort will also involve an increase in the use of Kendra’s Law, which lets courts mandate treatment for those who are a danger to themselves or others.
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.”
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.
Mr. 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.”
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 Mr. 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 the 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 the police, to certain emergencies.
One advocate for mentally ill people said that 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, chief executive of the New York Association of Psychiatric Rehabilitation Services and a longstanding critic of involuntary confinement.
He added: “This work is all about relationship and engagement and trust and reliability and putting in place this continuity of service — that’s what’s going to get us out of this, not more hospital beds and more Kendra’s Law orders.” He said that the mayor’s approach relied on “the same failed system that’s overburdened and can’t address the people they already have now.”
Mr. Adams warned that the new policy would take time to implement. “Nobody should think decades of dysfunction can be changed overnight,” he said. “The longest journey begins with a single step.”
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