Acting to address “a crisis we see all around us” near the end of a year that has seen a string of high-profile crimes involving the homeless, Mayor Eric Adams on Tuesday announced a major effort to ward off people with serious and untreated mental illness. streets and subways of the city.
Mr Adams, who has made clearing homeless encampments a priority since taking office in January, said the effort would require involuntarily hospitalizing people who posed a danger to themselves, even if they were not posed no risk of harm to others, arguing that the city had a “moral obligation” to help them.
“The common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent,” Mr Adams said in a speech at City Hall. “Going forward, we will do everything we can to help those who suffer from mental illness.”
The mayor’s announcement comes at a heated moment in the national debate over rising crime and the role of the police, particularly in dealing with people whose mental health is already fragile. Republicans, as well as tough-on-crime Democrats like Mr. Adams, a former police captain, have argued that the growing disorder calls for more aggressive action. Left-wing advocates and officials who dominate New York politics say deploying police as auxiliary social workers may do more harm than good.
Other major cities have struggled to help the homeless, especially those struggling with mental illness. In California, Governor Gavin Newsom recently signed a law that could force some homeless people with conditions like schizophrenia into treatment. Many states have laws that allow involuntary outpatient treatment, and Washington State allows people to be hospitalized if a judge finds they pose a threat to themselves or others.
New York officials said the city would immediately implement training for police officers, emergency medical services personnel and other medical personnel to “ensure compassionate care.” But the city’s new policy directive acknowledges that “jurisprudence does not provide detailed guidance regarding referrals for mental health assessments based on short field interactions.”
The policy immediately raised questions about who, exactly, would be involved in it, and some advocates for people with mental illness warned that it could face legal challenges.
Current state laws allow both police and medical personnel to involuntarily take people to the hospital when their behavior poses a threat of “serious harm” to themselves or others. Brendan McGuire, the mayor’s chief counsel, said on Tuesday that workers would assess people in public spaces “on a case-by-case basis” to see if they were able to provide for themselves with basic needs such as food, housing and health care.
The city’s guideline states that “unconsciousness or delusional misunderstanding of the environment” or “delusional misunderstanding of physical condition or health” could be grounds for hospitalization.
The effort will also involve an increase in the use of Kendra’s Law, which allows courts to impose outpatient treatment on those who pose a danger to themselves or others and which has been expanded by lawmakers in ‘Albany in April.
Often, homeless people with serious mental disorders are taken to hospital, only to be released a few days later when their condition improves slightly. Adams said the city would direct hospitals to hold those patients until they’re stable and only discharge them when there’s a workable plan to connect them to continuing care.
Hospitals often cite a lack of psychiatric beds as a reason for discharge of patients, but the mayor said the city will ensure there are enough beds for those removed from the streets. He noted that Governor Kathy Hochul had agreed to add 50 new psychiatric beds. “We’re going to find a bed for everyone,” Mr Adams said.
The number of homeless people with serious mental illness who do not live in shelters number, at the very least, in the hundreds. According to the Coalition for the Homeless, an advocacy group, studies have shown that a large majority of homeless New Yorkers have mental illness or other serious health conditions. About 3,400 people lived on streets and subways in January, according to an annual estimate often criticized as an undercount.
Since the pandemic, a series of random attacks on streets and subways has left many New Yorkers feeling the city has become more unpredictable and dangerous. .
Crime has risen sharply in the subway this year, and the mayor said last month: “When you analyze crime in the subway, you see that it’s driven by people with mental health issues.”
In January, days after the mayor took office, a woman was pushed to her death in front of a subway train by a man with schizophrenia who was cycling to and from hospitals, prisons and streets of the city for decades. The man, Martial Simon, has become a symbol of a failing system and prompted hearings by the state’s Attorney General and a stampede on the city’s public health and emergency response systems to tackling a problem that seemed insoluble.
Mr Adams stressed on Tuesday the importance of hospitalizing and treating people with serious mental illness even if they pose no threat to anyone.
“The man standing all day in the street in front of the building he was evicted from 25 years ago, waiting to be let in; the shadow boxer around the corner in Midtown, mumbling to himself as he punches an unseen opponent; the callous man unable to get off the train at the end of the line without the help of our mobile crisis team: these New Yorkers and hundreds of others like them urgently need treatment and often refuse it when they is proposed,” the mayor said.
While much of the mayor’s plan involves more extensive use of laws already in place, he said the city also needs Albany to fill “long-standing gaps in our state mental health law.” ‘State”.
The city would like the state to require hospitals to coordinate discharge planning with providers in the community and consider someone’s history, not just their current condition, when making admission decisions; let social workers and other non-physicians assess patients for Kendra’s Law orders; and expand the standard of involuntary hospitalization. Governor Hochul, in a statement, said the mayor’s plan would build on work the state and city were already doing.
Mr Adams has come under fire from some progressive members of his party for cleaning up homeless encampments and for continuing to push for changes to bail reform that would make it easier to keep people in jail. The mayor defended his focus on public safety and argued that many New Yorkers do not feel safe, especially in black and Latino neighborhoods.
Mr Adams held an event at a subway station on Monday to thank police officers who helped a homeless man who fell onto the tracks, an episode which he said ‘shows why we have focused on eliminating the homeless in our subway system”. He added: “The subway system is no place for people who need medical and psychiatric assistance.”
Earlier this month, the city’s public attorney, Jumaane Williams, released a report criticizing the mayor’s efforts to help New Yorkers with serious mental illnesses, saying some programs for them had declined and Ms. Adams was too dependent on the police.
On Tuesday, Mr Williams, along with several public defender organisations, including the Legal Aid Society, praised the mayor for bringing attention to the issue.
“Yet,” Mr. Williams said, “the mayor’s announcement leaves many unspecified details, unanswered questions, and the administration needs to provide more information on intentions, implementation and investment. non-policeman in his plan”.
Several advocates for people with mental illness said the mayor’s plan went too far and would prove counterproductive.
“The mayor spoke of a ‘trauma-informed approach,’ but the coercion itself is traumatic,” said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services and longtime critic. of involuntary isolation.
He said the mayor’s approach relied on “the same broken system that’s overloaded and can’t address the people they already have now.”
Norman Siegel, the former head of the New York Civil Liberties Union and co-founder of a volunteer outreach program, the Street Homeless Advocacy Project, which has been endorsed by the mayor, said the plan for the mayor lacked legal authority. He predicted it would be challenged in court.
“Just because someone smells bad, because they haven’t showered in weeks, because they’re mumbling, because their clothes are messy, doesn’t mean they’re a danger to himself or others,” Mr. Siegel said. “And they’re going to ask the cops, of all people, to make these decisions?”
The Brooklyn Center for Independence of the Disabled, an advocacy group, said the involuntary hospitalization constituted “discrimination under the Americans with Disabilities Act.”
Mr Adams warned that the new policy would take time to implement. “No one should think that decades of dysfunction can be changed overnight,” he said.
Councilman Tiffany Cabán said Tuesday on Twitter that the mayor’s plan was “deeply problematic” and that consent was essential to address it.
“Often the wrong speaker and the wrong response is what creates a deadly situation, not the mental health crisis itself,” she said.
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