New York City will ‘involuntarily’ hospitalize homeless people with severe mental illness: What we know

The country’s largest city is instructing officials to confront and involuntarily hospitalize people experiencing severe mental illness on the streets, New York City Mayor Eric Adams said Tuesday.

The aggressive move to get people with mental illnesses off the streets comes in a year when rates of homelessness in New York exacerbated shelters, and public concern surrounding crimes involving homeless people spiked. In his Tuesday address, Adams described city residents with severe and untreated mental illness who sleep on subway cars and park benches and said their living situations are “a crisis we see all around us.”

Despite the overwhelming demand for low-income housing in New York and crisis decades in the making, nearly 2,600 apartments for people with mental illnesses or those that are unhoused sat vacant in the city as of this month, The New York Times reported.

CONTEXT: There’s a huge overlap between people experiencing homelessness and people with mental illness, according to researchers at the Urban Institute, an economic and social policy think tank.

WHAT IT MEANS: Experts say homeless people may have a much harder time accessing consistent treatment for mental illnesses, because their everyday lives can be so precarious. At the same time, mental illness may make it considerably more difficult for someone without a place to live to find stable employment, pay for housing and fight homelessness.

New York Police Department officers wake up sleeping passengers and direct them to the exits at the 207th Street station on the A train, Thursday, April 30, 2020, in the Manhattan borough of New York. In New York City's latest effort to address a mental health crisis on its streets and subways, Mayor Eric Adams announced Tuesday, Nov. 29, 2022, that authorities would more aggressively intervene to help people in need of treatment, saying there was "a moral obligation" to do so, even if it means providing care to those who don't ask for it.New York Police Department officers wake up sleeping passengers and direct them to the exits at the 207th Street station on the A train, Thursday, April 30, 2020, in the Manhattan borough of New York. In New York City's latest effort to address a mental health crisis on its streets and subways, Mayor Eric Adams announced Tuesday, Nov. 29, 2022, that authorities would more aggressively intervene to help people in need of treatment, saying there was "a moral obligation" to do so, even if it means providing care to those who don't ask for it.

New York Police Department officers wake up sleeping passengers and direct them to the exits at the 207th Street station on the A train, Thursday, April 30, 2020, in the Manhattan borough of New York. In New York City’s latest effort to address a mental health crisis on its streets and subways, Mayor Eric Adams announced Tuesday, Nov. 29, 2022, that authorities would more aggressively intervene to help people in need of treatment, saying there was “a moral obligation” to do so, even if it means providing care to those who don’t ask for it.

What did NYC’s mayor say?

The city must do more to help people experiencing mental illness in public, especially people with untreated psychotic disorders, Adams said while laying out his 11-point mental health agenda for the upcoming legislative session.

As part of the new measures, city officials are instructed to hospitalize people “who pose a risk of harm to themselves even if they are not an imminent threat to the public,” Adams said.

The mayor stressed the policy guidance will affect people with mental illness who are not posing any threat to anyone besides themself. Until now, officials have operated by intervening and involuntarily hospitalizing some individuals who pose a risk to others, Adams said.

“A common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent, suicidal or presenting a risk of imminent harm,” he said.

Many people who are unhoused and suffer from mental illness in New York are in urgent need of treatment, “yet often refuse it when offered,” Adams said.

The mayor also added this group of people “cycle in and out of hospitals and jails” in the city.

A homeless outreach worker and New York police officer assist passengers found sleeping on subway cars at the 207th Street A-train station, Thursday, April 30, 2020, in the Manhattan borough of New York.A homeless outreach worker and New York police officer assist passengers found sleeping on subway cars at the 207th Street A-train station, Thursday, April 30, 2020, in the Manhattan borough of New York.

A homeless outreach worker and New York police officer assist passengers found sleeping on subway cars at the 207th Street A-train station, Thursday, April 30, 2020, in the Manhattan borough of New York.

How will the policy work?

The mayor’s directive would give outreach workers, city hospitals, and first responders, including police, discretion to involuntarily hospitalize anyone they deem a danger to themselves or unable to care for themselves.

As part of its initiative, the city is developing a phone line that would allow police officers to consult with clinicians.

The mayor said he has begun deploying teams of clinicians and police officers to patrol the busiest subway stations. The city also was rolling out training to police officers and other first responders to help them provide “compassionate care” in situations that could cause the involuntary removal of a person showing signs of mental illness in public places.

A spokesperson for New York Gov. Kathy Hochul said the city’s plan builds on mutual efforts to increase capacity at psychiatric hospitals, as well as expand outreach teams in subways.

Is this allowed?

New York law generally limits the ability of authorities to force someone into treatment unless they are a danger to themselves.

But Adams said state law allows officials to “intervene” when severe mental illness is preventing someone from meeting their “basic human needs.”

In his statement, Adams said when people aren’t able to meet their basic needs, they are “a danger to themselves.”

Advocates say ‘cycle’ of homelessness will continue

Advocates fighting homelessness have long argued helping people with mental illnesses who live on the streets requires a combination of housing and clinical services.

Individuals who are part of the population Adams described do need mental health services, but the broader struggles they face will not benefit from the new guidance, said Sarah Gillespie, a housing policy researcher with the Urban Institute.

“If you transport them to the hospital, I’m not sure what services they would receive and if there is no plan for permanent housing they will return to the street and the cycle will continue,” Gillespie told USA TODAY.

“Once someone is in housing, there are wraparound services,” she added, referencing behavioral health care that supports people at home, at school, and in other settings, via multiple trained care providers.

Under the new guidance, Gillespie argued, mentally ill people experiencing homelessness will continue to face a “cycle” of drug use, interactions with police, and jail time.

Homeless Outreach personnel reach out to a person sleeping on a bench in the Manhattan subway system, Monday, Feb. 21, 2022, in New York.Homeless Outreach personnel reach out to a person sleeping on a bench in the Manhattan subway system, Monday, Feb. 21, 2022, in New York.

Homeless Outreach personnel reach out to a person sleeping on a bench in the Manhattan subway system, Monday, Feb. 21, 2022, in New York.

Experts: Housing helps support people with mental illness

A study Gillespie conducted in Denver found stable housing was directly linked with better outcomes for people with mental illness and substance abuse disorders.

In the study, a randomized control group of people were offered housing and after three years, 77% of them remained in stable housing and avoided jail stays and trips to the emergency room, Gillespie said.

“When I read the policy and the announcement it’s framed as ‘these folks cannot meet their basic needs and that’s why they need this involuntary treatment,'” Gillespie said. “And so my argument would be if they had a place to live, there’s research evidence that tells us they would meet their basic needs.”

Contributing: The Associated Press

This article originally appeared on USA TODAY: Homeless in New York involuntarily hospitalized for mental illness