Adams has ordered the police to take mentally ill homeless people off the streets for their own protection.
When New York City mayor Eric Adams announced in late November a new vision for addressing the growing crisis of homeless people suffering from severe mental illness in the city’s streets and subways, he said it was an effort to lead with compassion and care.
It was a myth about state law, he said, that for a person who is showing symptoms of severe mental illness to be taken in for treatment against his will, he would have to have committed an overt and dangerous act. Too many people were being allowed to languish on the streets, in danger and in need.
A new directive, Adams said, would make clear to the city’s first responders and clinical co-response teams that they can intervene when it appears that mental illness is preventing a person on the street from meeting their basic human needs. “If severe mental illness is causing someone to be unsheltered and a danger to themselves, we have a moral obligation to help them get the treatment and care they need,” Adams said.
But while Adams saw his new directive as compassionate, many on the left and in the mainstream media saw something else entirely. Some leftist advocates called the plan draconian and a cruel and dangerous attack on the civil rights of the homeless. The mayor was “playing fast and loose with the legal rights of New Yorkers,” declared the executive director of the New York Civil Liberties Union, who also alleged that Adams intended to “sweep thousands of people off the streets.” Others accused Adams of scapegoating the mentally ill as particularly violent, threatening to hospitalize “people for being poor in public,” and engaging in a PR stunt.
There would inevitably be more dangerous encounters with police, they said, and anyway, the main driver of homelessness isn’t mental illness, but lack of affordable housing.
The reaction from critics was loud, and backlash to the plan dominated the headlines.
Some of the plan’s critics have simply mischaracterized certain aspects of it. For one, administration officials say they are not proposing a massive sweep of homeless people. “It’s certainly not something we expect to lead to a flood of newly-hospitalized people,” Adams adviser Brian Stettin said in a recent interview on the FAQ NYC podcast. And it’s also not a broad effort to address homelessness generally — it’s focused only on the subset of homeless people who are homeless because of a severe mental illness they may not even be aware of.
It also is not intended to be a big-picture solution to the crisis of untreated mental illness. Even proponents of the plan acknowledge that New York City, like essentially all big cities, lacks the capacity to address that problem of untreated mental illness comprehensively.
What Adams’s plan is, proponents told National Review, is an important shift in thinking and strategy after decades of deinstitutionalization efforts that pushed struggling people onto the streets and culminated in former mayor Bill de Blasio’s failed mental-health strategy, which cost more than a billion dollars but did little to help many New Yorkers with serious mental illnesses.
“I admire the mayor for trying to do it. I think it’s long overdue,” said psychiatrist E. Fuller Torrey, a longtime proponent of civil commitment for people with serious mental illnesses. But, Torrey said, it will be difficult considering the opposition and the lack of bed space in the city.
“Getting people to the hospital and getting them on medication and straightened out is the easy part,” he said. “The hard part is following up to make sure they stay on medication.”
Adams’s office did not respond to emailed questions from National Review for this story.
Lisa Dailey, executive director of the Washington, D.C.-based Treatment Advocacy Center, which was founded by Torrey in 1998, said that what Adams is trying to do is provide guidance to first responders that a hospital is the appropriate place for someone they encounter on the street who is dealing with a psychiatric crisis and can’t care for themselves.
“Right now, it’s really easy for that person to end up in jail, or to end up otherwise detained,” she said. “This is really a directive saying, this is a health condition. It should be handled in that system.”
‘Ticking Time Bombs Ready to Explode’
New York City councilman Robert Holden, a centrist Democrat from Queens, has been a longtime advocate for doing more to help people with severe mental illness who have become increasingly visible on the city’s sidewalks and in the subways.
“They’re all over the place. They’re talking to themselves. They’re screaming at people,” said Holden, describing some of those people as “ticking time bombs ready to explode.”
Holden said the de Blasio administration and its ThriveNYC effort, run by de Blasio’s wife, Chirlane McCray, had little interest in red-flagging New Yorkers with mental illnesses who could pose a threat to themselves or others. ThriveNYC was too broadly focused and operated with little accountability, critics said. Holden and others complained that it didn’t do nearly enough for the people most in need, and he said de Blasio had little interest in pushing for the enforcement or expansion of Kendra’s Law, which was passed in 1999 and allows judges to mandate that defendants with mental illness complete involuntary outpatient psychiatric treatment.
The law was named after Kendra Webdale, a journalist who was killed by a mentally ill man who pushed her in front of a subway train.
“When the current mayor, Adams, was running, I met with him several times, and I told him about Kendra’s Law, I told him about what the de Blasio administration was doing wrong, and I told him about mental health, how we have to really get [people with severe mental illness] off the streets for their own good,” Holden said.
Some opponents of the plan have accused Adams and others of scapegoating people with severe mental illness as particularly violent, when they say people struggling with mental illness are more likely to be victims of crime than perpetrators. Either way, Holden said, “there is nothing compassionate about leaving somebody on the street in twenty-degree weather.”
The problem of people with severe mental illness being left to the streets has its roots in the deinstitutionalization movement of the 1960s and 1970s, when state psychiatric hospitals were closed in part over concerns about poor care and inhumane conditions.
“We were very good at emptying out the hospitals,” Torrey said. “Theoretically, if we had provided the services for [the patients], you wouldn’t have the problems today. But we didn’t provide services for them. This goes back a long ways.”
Stephen Eide, a Manhattan Institute researcher who studies homelessness and mental illness, said the deinstitutionalization movement didn’t stop and has continued over the decades. But, he said, there is increasingly a “sense that we went too far, the pendulum swung too far, and there are people out there who would benefit from psychiatric hospitalization who aren’t getting access to it.”
Adams’s plan comes from that perspective and starts from the presumption that the New York law allowing for involuntary commitment has been too narrowly interpreted. “A common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent, suicidal, or presenting a risk of imminent harm,” Adams said. “Going forward, we will make every effort to assist those who are suffering from mental illnesses and whose illness is endangering them by preventing them from meeting their basic needs.”
Dailey said it is wrong to call Adams’s directive an expansion of what is allowed under New York law. Rather, it is more of a clarification about what Adams’s administration believes is already allowed. “We have criticized the New York statute in the past because it isn’t very clear,” she said. “But there’s nothing in the statute that would currently prohibit doing exactly what is laid out in this directive. It’s just that, that’s not really what the training has been, and it’s not the way that it’s been implemented.”
In addition to clarifying when first responders can bring people in for a mental-health evaluation, Adams has announced new clinical co-response teams – joint patrols of the city’s police department and the Department of Health and Mental Hygiene – that will be deployed in the city’s subways to respond to people who appear to be struggling with their mental health. He said the city is developing a tele-consult line that officers can use to consult with clinicians, and it will provide training to all clinicians, outreach workers, and first responders.
Adams also announced a new eleven-point legislative agenda around the issue. The agenda includes making it clear in state law that his approach to untreated mental illness is legal and correct, increasing the number of professionals who can conduct mental-health evaluations, and requiring evaluating clinicians to look at the broader context of a person’s situation — including their ability to adhere to outpatient treatment and their risk of suffering over time — when determining if their mental illness remains “likely to result in serious harm.”
Eide, with the Manhattan Institute, said Adams’s plan “is what a real commitment to serious mental illness looks like.” He noted that it’s not a plan to address New York City’s broader homeless population, which includes many people who aren’t seriously mentally ill.
“We have all these migrants that have shown up recently. There are single mothers living at a shelter with two or three kids. This plan has nothing to do with those groups,” Eide said. “But it does have this highly visible and important population who is living on the streets, out of the subway system — a population with a very elevated rate of untreated serious mental illness. And so, that population would be one of the prime beneficiaries of this policy.”
“We’re going to have to be talking about doing something like the mayor is talking about,” Eide added, “otherwise the inevitable result is going to be more neglect.”
‘We Need Beds’
Although Eide has praised Adams’s plan as “potentially transformative,” he and other supporters have agreed that critics who say the city doesn’t have the capacity to fully implement it have valid concerns. Even supporters note that the city is lacking in psychiatric bed space, hospital staff, outpatient psychiatric treatment options, and transitional housing.
“There are many things about mental-health care that are going to have to be addressed that aren’t part of this plan, particularly with regard to bed capacity,” Eide said. “What is the point of committing someone to a bed that doesn’t exist?”
During the worst of the Covid-19 pandemic, New York repurposed many of its psychiatric hospital beds for coronavirus patients. Most of those beds still have not been brought back on line, Stettin said in his podcast interview. Adams recently announced that New York governor Kathy Hochul has allocated 50 new long-term-care beds to provide up to 120 days of care.
“As we roll this out, we’re going to see the additional needs, and we’re going to staff up to those needs,” Adams said. But he, too, acknowledged that the city is lacking in psychiatric-bed capacity. “We need beds,” he said. “There’s no getting around that.”
Dailey, with the Treatment Advocacy Center, said implementing Adams’s plan should help city leaders to better understand the scope of the problem, so they can adjust resources.
“What happens is, you don’t have a real count of what your demand is,” she said. “We don’t know how many people should be in hospitals, and we don’t know exactly how bad our bed shortage is, because we’re not bringing all of the people who qualify for treatment, whether involuntary or voluntary, into hospitals. How do you know what your capacity needs are?”
In theory, Torrey said, lining up all the resources first is “the way it should be done,” but that’s unlikely. “Bringing people in will force them to find bed space and create bed space,” he said.
Holden is a proponent of reopening shuttered buildings and adding more beds to the state-owned Creedmoor Psychiatric Center in Queens Village. He said it will likely cost billions of dollars to build out a system with enough psychiatric beds and supportive and transitional housing. “The mayor is trying to set up the infrastructure,” he said.
Stettin acknowledged that the city has a long way to go to build up the continuum of mental-health care needed in New York City, and he said the mayor’s plan “should not be understood in a vacuum.” He also tried to tamp down expectations and concerns that Adams’s plan will lead to a drastic increase in psychiatric hospital patients.
“There’s nothing in the directive that has gone out from the mayor that suggests that we are going to be creating this new ambitious or aggressive sweep where we’re going to have lots more cops out there looking for lots more people and finding more reasons to hospitalize them,” he said. “I think it’s really unfortunate that it’s been characterized that way.”
Some critics have also raised concerns about the potential increase of dangerous encounters between law enforcement and people on the streets who are seriously mentally ill.
“That’s something we all should worry about,” said Torrey.
Dailey agreed there is risk there, but she noted that many of those encounters are already occurring. Instead of being taken to hospitals, people in need of psychiatric help are instead being cycled through the jail system. “Training is going to be extremely important,” she said.
Growing Consensus for Mandated Treatment
While much of the mainstream media coverage of Adams’s plan has focused on the opposition, Torrey, who has been advocating tougher involuntary-psychiatric-treatment policies for 40 years, said he believes journalists and the general public are giving his position more credence.
A poll of New York City residents last summer found that 89 percent agreed it should be easier to admit people to mental-health facilities if they are a danger to the public or themselves.
On Sunday, the New York Times profiled Torrey and called his influence on the city’s policy “profound.” The paper quoted Ira A. Burnim, legal director with the Bazelon Center for Mental Health Law, a legal advocacy center for people with mental disabilities that opposes Torrey’s efforts. Burnim accused of Torrey of helping to create a “fear of people with mental illness.” But he acknowledged that Torrey has been extraordinarily effective at building consensus for his position in favor of compulsory treatment for people with severe mental illness.
“We’ve lost,” Burnim said. “You’ve got to understand, we’ve lost.”
As big cities nationwide struggle with increasing levels of homelessness and untreated severe mental illness, Torrey said more people are coming around to the idea that the solution involves more than just building more housing, offering better services, and then persuading people — people who often don’t know they’re sick — to use them.
“I sense that there is a growing understanding among the public that you can’t just offer housing,” Torrey said. “There has to be more to it.”
“I’ve argued many times,” he added, “if I’m on the street, don’t know that I’m sick, I hope someone is going to violate my civil rights and get me help.”