On Tuesday, during a speech filled with passionate rhetoric, Mayor Adams unveiled his plan to involuntarily hospitalize unhoused New Yorkers with mental illness. The mayor has since released a written version of this plan — one that relies on dangerous guidance by the New York State Office of Mental Health (OMH) and omits any mention of meaningful alternatives to compelled treatment.
By now, many of us are familiar with what the mayor is selling. He insists there are too few inpatient options available for people with mental illness and claims that even where those options exist, people with mental illness are too ill to know they need them. And, most crucially, he submits that the government must step in to force mentally ill people to avail themselves of inpatient care, even where the law stands in the way.
The mayor’s proposal fundamentally misdiagnoses the problems impacting people with mental illness and proposes counterproductive interventions that are guaranteed to fail. A singular assumption drives the mayor’s proposal: that inpatient care is the right solution for the needs of the mentally ill, and the right intervention to keep our communities safe.
This assumption, however, has been discredited for decades. All reputable studies show that permanent housing and community-based treatment options are the only tools that improve prospects for people with mental illness, preserve their autonomy and agency, reliably reduce violence and build safe and stable communities. Because governments have persistently failed to fund these interventions, people with mental illness must fend for themselves, sometimes with disastrous results for their health and the health of their communities.
Under the mayor’s direction, the NYPD has raided homeless encampments, swept subways and targeted mentally ill people engaged in relatively innocuous conduct. Now, the city has announced a coordinated campaign to violate the constitutional rights of unhoused, mentally ill people.
Adams wants us to think he is piloting these initiatives because he cares about public safety. But these initiatives do not serve public safety. They merely create the illusion of public safety by disappearing people without solving the challenges underpinning their situation. If the mayor cared about public safety, he would direct an immediate infusion of resources into supportive housing, culturally competent outpatient services and other interventions that help people manage their mental health, support their loved ones and contribute to their communities.
He would then widely publicize the availability of these services, streamline and simplify enrollment processes, and provide mentally ill, homeless New Yorkers with treatment and services that work.
For example, we have yet to hear the mayor tout the importance of supportive housing for people experiencing mental illness. Countless studies — including studies authored by OMH officials — show that absent supportive housing, people with mental illness often decompensate and remain trapped in a vicious cycle of institutionalization. Supportive housing is a ticket to stability and affords people with mental illness a safe space from which to seek other supportive services. It is also a crucial good government measure that reduces municipal reliance on more costly interventions, such as intermittent hospitalization or incarceration. Yet the city has failed to fully utilize its existing stock of supportive housing or, more importantly, expand supportive housing options to ensure that all eligible people can benefit from these programs. With the rollout of his plan, the mayor missed a crucial opportunity to address this issue.
The mayor also missed a crucial opportunity to address shortages in other services, such as multi-disciplinary care management teams. Assertive Community Treatment (“ACT”) is one such form of care management that affords support from a team of professionals who affirmatively engage with patients to ensure their needs are met. Yet, last week, the mayor admitted he did not even know there are massive waitlists for ACT and similar services.
If Adams expands involuntary commitment, he will make our communities less safe, and he will do so without first piloting options that work. There is no doubt that in particularly rare and severe cases, hospitalization is warranted. But hospitalization is predominantly a temporary intervention that traumatizes patients and minimizes their prospects for long-term recovery. When patients are discharged from hospitalization, they are discharged into a city without housing and services and placed right back on the pipeline to future hospitalization. This cycle must end.
We implore the mayor to rethink his plan and reevaluate his disproven assumptions about what unhoused people with mental illness need. It is time for the city to jettison its reliance on institutionalization and meet its responsibility to the most vulnerable among us.
Short is a supervising attorney with The Legal Aid Society’s Prisoners’ Rights Project, which has litigated class action cases seeking the expansion of the mental health services system for New Yorkers with criminal legal histories.
