Subway Attacks Reveal How New York Is Failing Its Mentally Ill

A t least three people in New York City have been shoved by strangers onto subway tracks in the past two weeks. Two of the perpetrators were reportedly homeless. One of the victims would have died but for the fact that she landed in between the rails and ducked as the subway passed overhead.

Andrei Berman, a Metro Transit Authority representative, told NBC News that the attacks “have absolutely no place in our system” and insisted that the MTA will work “closely with law enforcement to ensure the safety of New Yorkers while riding the system.”

Sarah Fineberg, the interim president of New York City Transit for MTA, characterized an October attack as “outrageous, incredibly dangerous, criminal behavior,” and called on the NYPD “to have a more significant presence” in the municipal transit system.

Law-enforcement representatives, however, say that their hands are tied. Pat Lynch, the president of New York’s Police Benevolent Association, told the city’s subway riders to “keep both eyes wide open while in our transit system.

“The politicians have made it abundantly clear that they don’t want cops enforcing transit system rules, connecting the homeless with services, engaging with seriously mentally ill people or doing any of the things necessary to prevent these terrifying random attacks.”

Each of these responses would be described by the German political philosopher Eric Voegelin as “magic operations in the dream world” — displays of “disapproval” and “moral condemnation” that do nothing to solve the problem in question but serve only to pervade society “with the weird, ghostly atmosphere of a lunatic asylum.”

While reports described only one of the three offenders as being “emotionally disturbed,” most people given to shoving strangers onto subway tracks are probably dealing with some sort of psychiatric disturbance. The attacks therefore raise serious questions about the advocates, legislators, and bureaucrats who work with and in New York’s Office of Mental Health (OMH). They have transformed New York’s state and municipal mental-health systems and have reduced the state’s capacity to care for the most seriously mentally ill.

The OMH’s Statewide Comprehensive Plan for 2016 to 2020 set forth an agency-wide “Transformation Plan.” The goal was to overhaul the existing OMH and to create a “modern, progressive mental health system” in New York State. The transformation would be achieved by “re-balanc[ing]” the agency’s “institutional resources by further developing and enhancing community-based mental health services” and “reduc[ing] the need for unnecessary inpatient hospitalizations at State Psychiatric Centers.”

New York officials believed that by serving more of its OMH caseload in community-based, non-institutional settings, the state would save money and appear to be “modern” and “progressive” on the issue of mental-health care. The state proceeded to close hundreds of inpatient psychiatric beds in pursuit of this systemwide transformation. In 2000, New York State had 6,055 certified inpatient beds at state psychiatric hospitals, private psychiatric facilities, and public and private emergency rooms. By 2018, that number fell to 5,419, a decline of roughly 12 percent. New York City alone lost 452 psychiatric beds in that same period of time, which accounted for 72 percent of the statewide reduction in inpatient capacity in that period. The reduction in inpatient capacity has accelerated in the last five years, particularly in New York City. The average daily census at Creedmoor Psychiatric Center, the 300-acre state hospital in Queens serving the New York City catchment area, fell by more than 15 percent from 2016 to 2020.

These inpatient-bed reductions came with a promise from OMH to “ensure services are available in the community” for patients discharged from or eligible for admission to a mental facility. Unlike several other states around the country, which did not reinvest the savings from hospital closures into the mental-health system, New York reinvested its savings into community-based initiatives such as “advocacy, outreach and bridger programs,” and “family support and outreach programs.”

The problem with New York’s mental-health system is not a lack of funding for community alternatives. The problem is the community alternatives themselves. Psychiatric hospitals and inpatient psychiatric wards primarily serve three types of service-recipients. First are those in acute crisis who may be suffering a psychotic break or who have attempted suicide. Second is a proportionately small group of seriously mentally ill people who have been deemed incapable of living in the community, often called “long-stay patients” in reference to their protracted length of stay at a state psychiatric hospital. Finally, there are forensic patients, who are committed following an insanity plea or an adjudication of incompetence.

In New York, forensic patients are served in specialty forensic hospitals, which have undergone comparatively little “transformation” since the OMH overhaul began. The number of budgeted forensic beds in New York State fell from 756 to 720 between September of 2016 and 2020, a decline of less than 5 percent.

The people primarily affected by these bed closures, then, are those facing a psychiatric emergency and the long-stay patients who have been discharged following years of living in a dedicated psychiatric facility. Reducing inpatient capacity potentially deprives them of access to a critical link in the continuum of care if they face a psychiatric emergency or fail to thrive in the community.

The New York State Nurses Association found that between 2015 and 2018, the number of NYPD calls reporting emotionally disturbed persons (EDPs) increased by 23 percent. In that same period of time, the federal Department of Housing and Urban Development (HUD) found that the number of homeless people with serious mental illness living on the streets of New York City also increased by about 23 percent.

All of this, including the sporadic acts of violence on municipal transit, was the predictable result of New York State’s closing down hundreds of inpatient beds. Whatever the intended benefits of OMH’s system-wide “transformation,” reducing the state’s inpatient capacity at the expense of the most seriously mentally ill is a tradeoff with real human costs.