New York City’s latest plan to keep people with mental illness from languishing in public is being touted as a common sense strategy to help them.
By encouraging police and city doctors to take more mentally ill people to hospitals, even if they refuse treatment, Mayor Eric Adams says he is humanely tackling a problem instead of diverting the look. But his policy will face a legal challenge and a cold reception from some city lawmakers. In emergency rooms, psychiatrists must determine whether these patients should be hospitalized, perhaps against their will.
It’s not a simple decision.
“Some people come in and are very agitated, and they have to be restrained as soon as they come into the emergency room. … But there are also people who come in and they are very calm and quiet, but they just have tried to kill himself two hours ago,” says Dr. Joel A. Idowu, who heads the department of psychiatry at Richmond University Medical Center on Staten Island.
“A person who is stable now could become unstable tomorrow,” he said.
Adams, a police captain turned politician, announced the plan in late November. The first-term Democrat has focused on what he sees as restoring a disrupted sense of civic safety and functionality during the coronavirus pandemic. Among other things, the less traveled streets and subways brought new visibility to the people who lived there, some of whom were mentally ill.
Under state law, police can order people to be taken to hospital for evaluation if they appear to have a mental disorder and their behavior poses a substantial risk of physical harm to others or themselves. same.
This is often interpreted to mean violent or suicidal people. But Adams said he was using the space provided by law to reach out to people “whose illness puts them at risk by preventing them from meeting their basic human needs.”
The mayor cites “a moral obligation to help them get the treatment and care they need,” but civil liberties organizations and mental health advocacy groups denounce his response as draconian, indiscriminate and legally suspect. Critics rallied outside City Hall this week and demanded a federal judge stop the policy; a hearing is scheduled for Monday.
It comes amid efforts across the United States to separate mental health treatment from law enforcement, including the new nationwide 988 mental health crisis hotline and moves in New York and other cities to handle at least some crisis calls with behavioral health professionals instead of the police.
“We need to make mental health care like medical care, a health issue that is treated and treated by the right people with the right training, at the right time, in the right places,” said American Psychiatric Association president Dr. Dr. Rebecca Brendel. She argues that the reliance on law enforcement to respond to mental health crises unfairly criminalizes the mentally ill.
Adams said officers will have access to real-time feedback from mental health professionals and work to persuade people to voluntarily accept help. His administration stressed that while the police can send someone to hospital, it is up to doctors to decide whether the person should stay there or can be safely released for outpatient treatment.
The complexity and the stakes became tragically clear when a family in Rochester, New York called 911 in March 2020 about a loved one who was behaving erratically and saying he wanted to die. Once in the hospital, Daniel Prude responded calmly and appropriately to questions and said he was neither suicidal nor a murderer, according to grand jury testimony from a psychiatrist. The hospital released him.
Hours later, police found Prude running through the snowy streets of Rochester. Officers eventually restrained him until he stopped breathing; he was taken off life support a few days later.
Typically, when a patient presents for an emergency psychiatric assessment, the first step is to determine whether a medical condition or drug use is causing the person’s behavior. Otherwise, psychiatrists assess the patient partly by observing and asking questions. But they are also seeking information from loved ones, former mental health care providers and anyone else who can shed some light.
“You can’t just trust what you see or what the patient has told the nurse” because the person may not be able or unwilling to give the full picture, says Dr Madhu Rajanna , acting chief of psychiatry at St. John’s. Episcopal Hospital on New York’s Rockaway Peninsula.
Staff members might need to calm combative patients — St. John’s says it does not use restraints for this purpose and rarely employs sedatives — or determine whether cooperative patients who insist they feel better are really good enough to leave.
The St. John’s Emergency Room typically assesses eight to ten psychiatric patients at any given time, and each is expected to be admitted or discharged within 24 hours. (Some other hospitals may detain people for 72 hours for observation in specialized psychiatric emergency programs.)
Rajanna and Emergency Medicine Chair Dr. Leigha Clarkson said St. John’s 43 adult psychiatric beds are generally sufficient, although the hospital tries to release people quickly once it is sure.
Across the city, however, Adams’ new policy could test capacity after hundreds of psychiatric beds were converted for COVID-19 cases. The state recently promised 50 new psychiatric beds, and Adams promised “to find a bed for everyone who needs it.”
Many people may not. Richmond University Medical Center’s psychiatric emergency program, for example, discharges about 3/4 of patients after assessment, Idowu said.
Deciding whether patients stay or leave “can sometimes be stressful. Because it’s not perfect,” he says, but the goal is that “you don’t leave anything to chance”.
Associated Press medical editor Lindsey Tanner contributed from Chicago.
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