New York City to involuntarily hospitalize more mentally ill under new plan

New York City to involuntarily hospitalize more mentally ill under new plan

In a move he says is aimed at tackling the city’s mental health ‘crisis’, New York City Mayor Eric Adams on Tuesday unveiled a directive ordering police and first responders to remove people with severe symptoms of mental illness from the subways and city streets and taking them, even unwittingly, to area hospitals.

The directive, his office said, responds to an “ongoing crisis of people with serious mental illnesses who are untreated and homeless on the streets and subways of New York City.”

“These New Yorkers and hundreds of others like them urgently need treatment, but often refuse it when offered,” Adams said at a press conference announcing his initiative. “The very nature of their disease prevents them from realizing that they need intervention and support. Without this intervention, they remain lost and isolated from society, plagued by delusions and disordered thinking. They cycle in and out of hospitals and prisons.

The new directive would give the city’s mobile crisis teams, police, fire and other emergency response teams a “step-by-step” process to assess and take those with mental health symptoms to the area hospitals for evaluation. Adams said these workers will “receive enhanced training on how to help people in mental health crisis” to make those decisions and “caring compassionately for people in crisis.”

First responders will work with clinical co-response teams deployed to New York City subways to help with a coordinated mental health response, Adams said Tuesday.

The move was criticized by some mental health professionals who said the city should focus on long-term solutions and avoid treating people who refuse.

“My most salient concern is that this plan relies too heavily on coercion and involuntary use of hospitals, and adding coercion to a broken system that is inadequate to begin with doesn’t really address the fundamental problems of commitment. and access to quality care,” said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services.

New York Civil Liberties Union executive director Donna Lieberman also condemned the plan.

“The mayor is playing fast and loose with the legal rights of New Yorkers and failing to dedicate the resources necessary to address the mental health crises affecting our communities,” Lieberman said in a statement. “The federal and state constitutions place strict limits on the government’s ability to detain people with mental illness — limits that the mayor’s proposed expansion is likely to violate. Forcing people into treatment is a failed strategy to connect people to long-term treatment and care.

Adams said there is a ‘myth’ surrounding ‘involuntary assistance’ that only applies when there is imminent harm and that the city ‘won’t give up’ on hospitalizations even if it’s against an individual’s will. The mayor invoked the full power of “Kendra’s Law,” New York’s legislation that allows court-ordered assisted outpatient treatment. The law is named after Kendra Webdale, who died after being pushed onto the subway tracks by a man with a history of mental illness.

The city acknowledged that the legal landscape for this type of authority can be murky, saying in the guideline that “jurisprudence does not provide detailed guidance regarding referrals for mental health assessments based on short on-the-ground interactions.” .

But he suggested several situations in which the need for involuntary hospitalization might be reasonable, including “untreated serious physical injury, delusional unconsciousness or misunderstanding of the environment, or delusional unconsciousness or misunderstanding of physical condition or health”.

The plan is part of a larger 11-point legislative agenda Adams hopes to push through the state legislature. Some of the points include updating the state’s legal standard for involuntary hospitalization, which Adams says is too narrow; mandate coordination between inpatient and outpatient mental health care providers after an inpatient is discharged from court-ordered mental health treatment; and requiring hospitals to share treatment records with city health officials conducting a court-ordered outpatient investigation, but only after the patient has had a reasonable opportunity to challenge the disclosure in court.

The mayor’s plan also comes as New York City continues to battle transit crime. Several people have been stabbed on the subway this year and Michelle Go, a 40-year-old woman, died after being pushed past a subway train.

The incidents led Adams and New York Governor Kathy Hochul in February to announce a new safety plan to address public safety concerns and support those homeless and with serious mental illness on city subways. It also aimed to crack down on people sleeping on train platforms, exhibiting aggressive behavior towards passengers or creating an “unsanitary environment” in the subway system.

Rosenthal said while the mayor hints at good policies, his overall approach misses the mark because he prioritizes hospital stays — a short-term fix — over investing in long-term solutions. long term.

“We are not going to the hospital to get out of this problem. We’re not going to use Kendra’s law to solve this problem,” he said.

Instead, he said, the city needs sustained commitment, housing, health care support and financial assistance for those in need.

“We have approaches that already engage populations like this, we don’t invest in them, we fall into ‘the answer is coercion’.”

Adams noted that bed availability and hospital infrastructure would need to be beefed up to be ready for his plan and that Governor Hochul had agreed to add 50 new psychiatric beds in a bid to open up space.

Adding 50 beds, however, would not be enough if hospitals require longer stays as Adams’ plan proposes, said Taina Laing, chief executive of Baltic Street AEH, Inc, a mental health organization run by peers based in Brooklyn.

“He’s looking for longer-term hospital stays until the person has stabilized, but hospitals don’t have the capacity for that kind of long-term stay in a forced setting,” Laing said. .

Laing also noted that officers have had a strained relationship with residents, especially those who suffer from mental illness.

“We live in a society right now where they just don’t trust the police, so if a person is in crisis they don’t want to see a police officer,” she said. “They prefer to see a peer specialist or a behavioral health specialist.”

Some mental health professionals say police were already acting as mental health responders before Adams’ directive, and the new directives will bring more people in front of medical professionals as opposed to jail cells.

“Involuntary commitments have been around for a long time and this is the number of patients, unfortunately, who have been coming to hospitals for years, so we need to be aware of how this could further perpetuate stigma and reluctance to be made. treat,” said Dr Sue Varma. , a board-certified psychiatrist in New York City.

“In an ideal situation, you want mental health crisis teams to be on the front line. If we want to invite people to voluntarily seek treatment, we need to know what that invitation looks like,” she said.

“Ultimately, the decision to hospitalize should ultimately be made by the patient and their treatment team. The goal is always to keep a person in the community, stable and healthy for as long as possible.

Varma said the mayor’s plan steers the conversation in a direction that expands services, but at the same time raises the question of how to keep people healthy over the long term so they can remain active participants in their own treatment.

Dr. Victor Schwartz, senior associate dean at the City University of New York School of Medicine, said it’s better for police to get people to the emergency room “where they can be both medically and psychiatrically checked rather than to bring them to the criminal”. justice system in a prison system where there is medical care, but much less than in a hospital setting.

Schwartz said he often sees people with mental health issues go through the criminal justice system, so while this directive would redirect one aspect, the plan is just a “stop-gap maneuver.”

“It’s unfortunate to have to use acute care hospitals for people who in many cases would probably do better in other kinds of supportive settings, but unfortunately we’re in this crisis because other kinds of services have been underfunded.”

Schwartz thinks the ideal solution would include an array of supports in communities ranging from supportive housing to case managers to the ability to ensure people are adhering to treatment as well as access to psychosocial support.

“I think there’s a sense of pressure to take dramatic action or stand up, change the dial quickly, but if that’s done without paying attention to the larger needs of the system, then it’s really like putting a dressing on a bleeding wound.”

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