Many New Yorkers agree that the city needs to do more to help those with severe mental illness who roam its streets and subways.
But on Wednesday, one day after Mayor Eric Adams announced an aggressive plan to involuntarily hospitalize people deemed too ill to care for themselves, experts on mental illness, homelessness and police expressed skepticism that the plan could effectively address a crisis that city leaders confused for decades.
Mr Adams said he instructed police officers and other city workers to take people to hospitals who posed a danger to themselves even though they posed no risk to others, putting the city at the center of a national debate about caring for people with severe mental illness.
Mental health experts and elected officials applauded the mayor’s attention to the issue, but also raised questions about how his plan would be implemented, how many people could be affected and whether police officers should be involved.
Mr Adams acknowledged that New York did not have enough psychiatric beds to house everyone, and said the city would start training police officers to respond with compassion.
William J. Bratton, the former New York City Police Commissioner, said Mr. Adams was trying to do the right thing, but his plan would be very difficult to implement.
“There is no place to house many of these poor souls,” he said. “It is a well-intentioned measure and it is long overdue to try to deal with this seemingly intractable problem in a more humane way.”
After a decades of deinstitutionalization who closed thousands of psychiatric beds, and the loss of more beds during the pandemic, the city suffers from a chronic shortage of psychiatric hospital beds. Hospitals are under constant pressure to clear beds to make room for new psychiatric emergency patients.
Even if enough hospital capacity can be created to admit many more people, it is unclear what will happen if the hospital fires someone.
Some people would be taken to specialized shelters for people with mental illness. Some of those shelters have a very spotless track record of keeping their residents out of trouble. Subway crimes have increased and the mayor has blamed people with mental illness.
But in general, most crimes in the city are not committed by people who are not housed or who are mentally ill. And in many cases, those committing crimes may already be wired to resources that the city will provide under the new plan.
Experts say the best place to put someone with a serious mental illness after they leave a hospital is usually supportive housing, which comes with on-site social services, and has the best track record of helping people in the long term to keep stable. But while the city and state are accelerating plans to create more supportive housing, there is so little supply four out of five qualified candidates are rejected.
Just finding providers of outpatient psychiatric care, vital to breaking the cycle of hospitalization and prison into which so many people with mental illness find themselves, is difficult.
“Outpatient clinics are booked up for months, if they even take referrals,” says Bridgette Callahan, who leads teams of field workers who treat the most seriously mentally ill people on streets and shelters for the Institute for Community Living, a nonprofit organization under a city program called Intensive Mobile Treatment.
Mental health advocates also said the plan infringed on people’s rights. They argued that police officers should not be responsible for deciding who should be transported to hospitals.
“Instead of taking the least restrictive approach, we are going to the extreme that takes away basic human rights,” said Matt Kudish, CEO of the National Alliance on Mental Illness of New York City.
Mr. Bratton, who served as police commissioner under Mayors Bill de Blasio and Rudolph W. Giuliani, said the plan was risky for Mr. Adams and that leaders across the country would be watching New York’s approach. It will take months to properly train police officers in conducting psychological evaluations and dealing with people who resist transportation to hospitals, he noted.
“The police will see this as another burden placed on them,” he said.
New Yorkers should not expect dramatic changes to occur overnight. The city began training doctors who work with patients on the new guidance on Tuesday. It will begin training police officers and emergency medical services personnel in the coming weeks, city officials said.
Mr. Adams acknowledged on Tuesday that the city would need many more psychiatric hospital beds for his plan to succeed, and said he would work with state lawmakers in Albany to add beds. Gov. Kathy Hochul, who has said she supports the mayor’s efforts, recently announced that the state was setting up two new units in psychiatric centersincluding 50 hospital beds.
Jody Rudin, a former deputy city commissioner of homeless services who is now CEO of the Institute for Community Living, applauded the mayor for “bogging and talking about this issue.”
“There seems to be an appreciation for the need for trauma-informed and community-based services, not just lip service, and to some extent he’s putting his money where his mouth is,” she said.
But Ms Rudin said most of the people who need the most help are already well known to clinicians who do outreach work. And she said she was concerned that those people wouldn’t be consulted by police officers, emergency workers or hospital staff who the mayor said would man a new hotline, to decide whether to take someone to a hospital against their will.
“If done in a coordinated way, it can be very helpful to people’s ability to live healthy and fulfilling lives,” she said. “If it’s done in a messy and uncoordinated way, we’re very concerned.”
Jumaane Williams, the city’s public advocate, and other left-wing elected officials, have expressed concern about police officers assessing people on the street and the lack of details about what care people will receive once they are removed.
“That’s a big red flag right there,” Mr Williams said.
Mr Williams said that while he was pleased that Mr Adams is committed to helping people with severe mental illness, he was concerned that black men would be disproportionately affected by the new policy and that people would be banned from overburdened hospitals . He said the city should concentrate on financing less intrusive programmes such as homeless shelters, where people can get a hot meal and shower, and urgent care centers for mental health care.
“You have to put the funding into the programs that are needed so you don’t have to do this,” he said.
Ron Kim, a left-wing MP from Queens, said he supported the plan because he believes Adams wants to rebuild the government to help the public.
“He says accountability stops here – he says we’re going to activate city workers to intervene,” Mr Kim said.
Mr Kim said he was moved by a recent dinner with Michelle Go’s father, who was too killed in January when she was pushed in front of a subway train by a homeless and mentally ill man.
“I was shocked to learn that because of the pain he was going through, he wasn’t focused on punishing the attacker,” said Mr. Kim. “He was really furious about the fact that we didn’t see the signs and that we didn’t intervene.”