Eric Adams, James Mark Rippee, and Some Mercy for the Mentally Ill Men and Women on Our Streets

Some of the reflexive opposition to Eric Adams’s efforts to help people who are homeless and mentally ill is inhumanely infuriating:

Noah Rothman writes about it at Commentary:

The New York Times headline blares: “New York City to Remove Mentally Ill People From Streets Against Their Will.” The reality of Mayor Eric Adams’s proposal is vastly more complicated.

Citing existing state law and court precedent, Adams revealed on Tuesday that the city’s social workers, first responders, and city-run hospitals will be allowed to commit the violently disturbed predicated on a clinical assessment of the danger they pose to themselves and others. This initiative is coupled with the development of a “tele-consult line” to provide police with instant access to clinicians who can, for example, help distinguish mental illness from the symptoms of drug abuse. The city has also drawn up an 11-point legislative plan aimed at augmenting facilities, closing administrative gaps, and amending applicable statutes.

The literature around the mayor’s initiative is littered with explicit caveats designed to mollify the squeamish. The screening requirements, mandatory psychological evaluations, and layers of legal authority and input from “community providers” are designed to ensure that, human error notwithstanding, this authority will not be abused. Its foremost purpose is to ditch the standard that once rendered psychiatric commitment entirely punitive—a response only to an “overt act” of violence. But to hear advocates of “unhoused people” tell it, Adams is wielding authoritarian powers to cleanse the city of its most vulnerable population. And for little more than the cosmetic effects.

In the New York Post, Stephen Eide and Carolyn D. Gorman of the Manhattan Institute write that his plan could be transformative:

To understand what the mayor is trying to do here, it’s best to think of psychiatric hospitalization as a process with three parts: initial contact with crisis response personnel the experience of hospitalization, and discharge. Adams’ plan proposes reforms to each of these three parts. He wants to expand access to hospitalization and make it more effective.

First, it clarifies when frontline mental health providers or police should initiate involuntary commitment. Adams argues that state law’s standard of “likely to result in serious harm” has been interpreted too narrowly. Providers have operated in an overly reactive mode, waiting until someone manifests “a demonstrated risk of violence, suicide or serious bodily injury” before committing that person to a hospital.

The Adams plan calls for making an evaluation for commitment when someone’s “basic living needs” aren’t being met because of their mental illness. The mayor believes he already has authority to direct providers to abide by this “basic living needs” standard, citing guidance from the New York Office of Mental Health, but he also seeks to codify it in state law next session.

Second, the Adams plan directs doctors to consider a patients’ history when determining whether it’s safe to discharge them. Too often, psychiatric inpatients are released because treatment has tamed their psychotic symptoms, but only temporarily. After being “treated and streeted,” they start deteriorating almost immediately upon discharge.

Adams’ plan directs doctors to weigh factors from someone’s past, like willingness to stick with treatment outside the hospital context, when deciding if discharge is appropriate. Requirements for discharge planning are determined by the state, so this would also require action by Albany lawmakers.

Third, when discharge becomes appropriate (Adams reaffirms that “care, community, and treatment in the least restrictive setting possible” is the overall goal of mental health policy), the mayor’s plan requires hospitals to evaluate patients for Kendra’s Law. Kendra’s Law mandates treatment for seriously mentally ill individuals who have had a troubled past but are considered capable of community living. Making evaluation for Kendra’s Law a mandatory part of discharge will require state action.

. . .

Adams calls for changing the “culture of uncertainty” in mental health that makes the system too reluctant to intervene. The problem may just as well be described as a culture of abandonment.

New York progressives celebrate the city’s uniquely robust spending on social programs. But this is also a city where the typical response to encountering a mentally person deteriorating in squalor in public is to shrug.

Please read the whole thing here.

To actually care about the stakes of this controversy, look to San Francisco and the life and death of James Mark Rippee:

James Mark Rippee, who was blind, severely mentally ill, homeless — and unhelped, despite all the years that his sisters spent trying to change that — died on Tuesday at age 59. You could say, as doctors at Fairfield North Bay Medical Center did, that he died of multiple organ failure after an untreated urinary tract infection caused sepsis. Or you could say that the cause was really the 1987 motorcycle accident that took his sight and part of his frontal lobe more than half a lifetime ago, when he was 24. Over the next few years, his brain injury robbed him of his sanity and safety, too. You could consider some corner of accountability for the entrepreneur who had lately been charging him $600 a month to let him sleep in his backyard, along with other homeless people, though no one knows who left Mark at a Vacaville ER unable to breathe at 2:30 on Saturday morning, long after he should have received medical care. Or you could say that he died because we just didn’t care enough whether he kept on living.

. . .

Mark thought the voices he heard were being broadcast by extraterrestrials from a military submarine using “mind warfare” to turn “almost every single person in my life against me.” Unseen guilty parties were, he told me, doing all sorts of unethical experiments on homeless people. And in that last delusion, was he altogether wrong?

Anyone who doubts that Mark was not capable of freely choosing or rejecting treatment can clear up his confusion by spending five minutes with one of the many severely mentally ill homeless people screaming nonsense at no one on the streets of Sacramento and every other city.

Another bill that might have kept Mark alive was state Sen. Susan Eggman’s legislation, which would expand California’s definition of “gravely disabled” to make it easier for people like Mark to get help. Though his initial diagnosis was a traumatic brain injury, he supposedly still didn’t qualify for a conservatorship on a medical basis. In Solano County, he somehow didn’t qualify for a conservatorship based on his mental illness, either. Every county interprets “gravely disabled” differently, an absurdity that Eggman’s bill would correct. Mark’s sisters feel that their county just didn’t want to pay for the public conservatorship he needed. “He does have the ability to make some decisions for himself,” Solano County’s Huber told me last summer, and so was not considered “gravely disabled” enough to get the long-term residential treatment he so desperately needed. But, Huber added, that treatment wouldn’t be available anyway because even the prospect of funding something like that “is pretty bleak for small counties like ours.” And “every county has a Mark. Every county has multiple Marks.”

A man whose sisters were begging for help for their brother is dead because no one would help. Families face this heart-wrenching reality: A loved one can’t recognize they are sick, and they are over 18 so no one can insist they get treatment. I’m all for freedom, and of course don’t want involuntary treatment abused, but people like Mark are enslaved and need someone to free them.

God bless Melinda Henneberger for fighting for Mark and all the other Marks, who I pray has the mercy of God before him, even as he suffered our lack of it on our city streets.

Please, we need to stop passing people by and shrugging. We need to look at human faces and care to help.