Ahead of New York City’s coldest months of the year, Mayor Eric Adams has proposed a new legislative agenda addressing concerns over homelessness and mentally ill individuals, calling for systemic changes to health and housing systems.
As part of this plan, the Psychiatric Crisis Care Legislative Agenda allows Mobile Crisis Teams to involuntarily hospitalize people they deem unable to care for their well-being due to severe mental illness, even if they pose no threat to themselves or the public. The plan focuses on those individuals who exhibit “unawareness or delusional misapprehension of surroundings, or unawareness or delusional misapprehension of physical condition or health.” This essentially is an expansion of Kendra’s law, a law that provides court-ordered assisted outpatient treatment.
In response to this policy shift, New York's growing network of nonprofits committed to assisting New Yorkers suffering from mental health, substance abuse and homelessness are not fond of the memorandum.
According to Adams’ press release, the plan was created in order to address, “a gray area where policy, law, and accountability have been unclear,” and where the current system has “allowed people in desperate need to slip through the cracks.” Both nonprofits and medical professionals have been critical of this approach and how it may impact available hospital space. Since the onset of the coronavirus pandemic, hospitals across New York have struggled to maintain a consistent number of available hospital beds, while hospital workers have felt burn out from overwork amidst staffing issues.
Dr. Craig Spencer, former director of global health at New York-Presbyterian and Columbia University Medical Center told Gothamist, “the hospital isn't the place that magically fixes problems, especially a lot of these longer-term chronic issues.” Spencer noted, “we need to think about what this means for hospital staff and for others that don't have the resources we need right now to deal with the current patients.”
After the Adams plan was unveiled, multiple organizations have proposed opposing solutions. The Front End Project by Foundation House, a coalition of organizations aiming to transform public health and mental health crisis response, released a report highlighting their recommendations for community-based action and policy reform, centering around racial justice and equity. The comprehensive mental health emergency response plan, “From Harm to Health: Centering Racial Equity and Lived Experience in Mental Health Crisis Response,” proposed North Star Vision, a system emphasizing the importance of public health through a racial equity lens. Prioritizing the involvement of people with lived experience when forming crisis response frameworks, The Front End Project wants to ensure mental health care is accessible and equitable, while allowing people in crisis to have autonomous choices.
“While respecting that Mayor Adams and his administration have increased the focus on how to provide supports and resources to unsheltered people with (serious mental illness), we are concerned about any effort that utilizes short-term, involuntary measures as a starting place,” Foundation House writes in a press release, “We are equally concerned about steps that rely heavily on law enforcement when there are successful models that place public health workers at the forefront to engage this community that could be expanded.”
Recommendations by Fountain House include the roll out and implementation of a hotline for mental health emergencies. It would be an alternative to calling 911. Other recommendations are investment in anti-racism training and incorporating psychiatric advance directives, which can legally provide for someone’s stated preference for mental health treatment.
VOCAL-NY, a statewide grassroots organization working to empower minority groups facing disproportionate impacts of homelessness, mass incarceration and public health crises, is actively advocating against Adams’ psychiatric care plan.
“New Yorkers will see this plan for what it is: a draconian attempt to say the Adams’ administration is tackling a problem, while only making it worse,” said Jawanza Williams, director of organizing for voices of community activists and leaders at VOCAL-NY in a statement. “The lives of people dealing with mental health crises won’t be improved by forcing them into treatment, especially if it’s coming from law enforcement. All this directive will do is disappear them.”
“What does involuntarily mental health treatment mean to a flesh and blood person like me? Standing right here, it’s violence and humanization, but they’re calling it treatment. It’s sitting in a crowded room, like I was when I was committed earlier this year” Ibrahim Ayu, VOCAL-NY’s civil rights union leader, told attendees at the rally.
National Alliance on Mental Illness of New York City, which focuses on mental health support, education and advocacy, providing free services in an effort to increase accessibility to mental health services and peer-based support, has advocated for the passage of the Treatment Not Jail Act, legislation that ensures court participants are not jailed without due process. NAMI-NYC, among other organizations, has also advocated for programs and services that are run by peers who are trained to handle mental health crises.
Following Adams’ mental health proposal, Matt Kudish CEO of NAMI-NYC, released a response calling the administration’s expanded use of (assisted outpatient treatment), “beyond problematic.” “AOT is a last resort mechanism, not a mental health response. People living with (serious mental illness) have a right to person-centered and recovery-oriented mental health care. Instead of using the least restrictive approach, we are defaulting to an extreme that takes away basic human rights.”
Echoing the sentiments reported from fellow nonprofits, Kudish highlighted the lack of hospital preparedness, advocating for the increased investment of the behavioral health care system and housing.
Coalition for the Homeless, an advocacy and direct service organization helping homeless individuals and families, also spoke out against the Adams plan, requesting instead that affordable housing and support services be provided. “Mayor Adams continues to get it wrong when it comes to his reliance on ineffective surveillance, policing, and involuntary transport and treatment of people with mental illness,” wrote Jacquelyn Simone, policy director for the coalition, in a press release. Adams, she said, should “prioritize bringing access to quality voluntary care and affordable, permanent housing with support services to New Yorkers who need it the most.”