OT? Involuntary hospitalization of the homeless

New York City to Involuntarily Remove Mentally Ill People From Streets

Mayor Eric Adams directed the police and emergency medical workers to hospitalize people they deemed too mentally ill to care for themselves, even if they posed no threat to others.
By Andy Newman and Emma G. Fitzsimmons, The New York Times, Nov. 29, 2022

Acting to address “a crisis we see all around us” toward the end of a year that has seen a string of high-profile crimes involving homeless people, Mayor Eric Adams announced a major push on Tuesday to remove people with severe, untreated mental illness from the city’s streets and subways.

Mr. Adams, who has made clearing homeless encampments a priority since taking office in January, said the effort would require involuntarily hospitalizing people who were a danger to themselves, even if they posed no risk of harm to others, arguing 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 an address at City Hall. “Going forward, we will make every effort to assist those who are suffering from mental illness.”…[end quote]

When I was growing up, it was considered the sign of a benevolent society to place mentally ill people into mental hospitals. We even studied the history of the development of treatment of the mentally ill, from having noplace to put them (living in the streets) to primitive asylums (“Bedlam”) to the development and government financing of public mental hospitals.

During the 1970s, there were public exposes of mistreatment of patients in mental hospitals. Coinciding with a movement during the 1970s for rehabilitation of people with severe mental illnesses, the Mental Health Systems Act supported and financed community mental health support systems, which coordinated general health care, mental health care, and social support services. The Omnibus Budget Reconciliation Act of 1981 repealed most of the MHSA.

I saw this as a devil’s bargain between liberals and conservatives. The liberals wanted freedom for the mentally ill. The conservatives wanted to spend less on the mentally ill. The idealistic concept of small, cozy community homes for the mentally ill never happened because it was expensive and complex. The big mental hospitals were shut down with nowhere to send the mentally ill.

The pendulum swung back. The mentally ill are on the street again.

I agree with Mayor Adams that the homeless mentally ill should be involuntarily committed to hospitals. (Since drug addiction is currently classified as a mental illness, this would include addicts.)

But actual hospitals – that is, emergency rooms where people are brought for trauma, heart attacks, inability to breathe due to Covid, etc. – are already overwhelmed. The treatment rooms are not equipped to hold the mentally ill, who are often destructive. (Including crazy addicts on synthetic meth.)

ERs are meant to hold people for only a short time before they are transferred to treatment beds. Hospitals aren’t set up for long-term care. Hospitals actually lose money if they hold patients for more than a few days in treatment beds. (Jeff can talk about this since he is on the board of a local community hospital.) I was kicked out of the hospital the day after my bilateral mastectomy even though I would rather have stayed a few days.

Many will disagree with involuntary hospitalization of the homeless on human rights grounds. Even those who agree with the policy need to analyze the practical implementation.

This is a large problem.

In January 2015, the most extensive survey ever undertaken found 564,708 people were homeless on a given night in the United States. Depending on the age group in question and how homelessness is defined, the consensus estimate as of 2014 was that, at minimum, 25% of the American homeless — 140,000 individuals — were seriously mentally ill at any given point in time. 45% percent of the homeless — 250,000 individuals — had any mental illness. More would be labeled homeless if these were annual counts rather than point-in-time counts.

Every state in the United States incarcerates more individuals with severe mental illness than it hospitalizes. Incarcerations are due to lack of treatments such as psychiatric hospital beds. This mixes the mentally ill with criminals in jail which has to be worse than putting the mentally ill into mental hospitals with medical supervision.

I think it’s time for society to go through the thought process that it did in the mid 1800s when, over a 40-year period, Dorothea Dix successfully persuaded the U.S. government to fund the building of 32 state psychiatric hospitals. (A Brief History of Mental Illness and the U.S. Mental Health Care System)

The high cost of building and maintaining adequate mental hospitals, with follow-up of patients who are released with psychiatric medications, may make this a Macroeconomic issue. It would be a new line item on a long list of costly government entitlements. It’s not even clear what combination of the federal, state or local government budgets would pay.

But the problem certainly shouldn’t be laid directly onto hospitals that are already struggling with unreimbursed care.

Anyone who doesn’t like to see homeless people living on the streets needs to figure out a practical way to take care of them.



I don’t know if there was any “liberal” cohort wanting patients to be free in Michigan. There certainly was a push by the (L&Ses) in Lansing to cut funding for mental health. Now, as you say, the County Jails are where the ill end up, where they can be housed, clothed, fed, and medicated. The most important thing, as far as the (L&Ses) in Lansing are concerned, is the cost of their care is moved off the state budget, and onto the counties.



It was a liberal thing everywhere. And rightly so. After a few exposes on the news about how badly treated some of the mentally ill were at those institutions, anyone with even the slightest liberal tendencies was convinced to “let them go free”. Heck, I know some pretty staunch conservatives that also were convinced after seeing those exposes. I think it was where Geraldo Rivera gained his fame, or maybe I am misremembering the name.


You are correct, Sir. Geraldo did a major expose’ on mental hospitals the upshot of which was they made One Flew Over the Koo-Koo’s Nest look like a Del Webb gated golf community. “Open the cells and rubber rooms!” was not the plan, though. Plans were proposed to create a sort of half-way house environment for most of them. (Some cases are simply too severe and will need the hard core hospital environment) The cost was to be covered by current spending simply being re-directed and assisted with some new spending get it up & going. But when the governments saw how much money they could save (keep…?) by building insufficient new facilities AND not spending on the already derelict mental heath system, they went with Plan B.


Freedom for the mentally ill? That was not what the liberals wanted.

The conservative lawyers argued freedom of speech for the mentally ill. This began a process of emptying out the cozy homes to save money in the 1980s.

It had next to nothing to do with the liberals or liberal lawyers.

It was a very disingenuous move to save money. Nothing really to do with rights.

Many lives were lost on cold lonely nights under cardboard. Veterans’ lives very often.

Just about zero to do with liberal lawyers.

Judges and lawyers under the new deal and then demand side econ up until the early 1980s had agreed that the mentally ill would not have certain rights if self harm was to happen. Or in other words turning a mentally ill person out into the cold of winter to die would not be how we operated in the courts. To save money only that was overturned by the right as freedoms.

How do I say this better…the law recognized mental illness and the needs of the mentally ill until money was to be saved and those laws were challenged.


Let’s not forget the movie “One Flew over the Coocoo Nest.” Presented the mentally ill as almost normal. Also thorazine drug became available for schizophrenia making treatments possible. Also lithium carbonate treatment for bipolar. Followed by many more.

Saving money may have been a driver for closing mental hospitals. But technology seemed to offer a whole different treatment program.

At this point those expectations were not achieved at least for some. But you wonder how many of those patients went home and have done ok. They don’t get in the news.


Many, many Americans have “done OK” at home on psychiatric medications. The number of Americans taking mental health prescription medication is up 6.4% in the last year, which means that 65 million people (1 in 5) are now prescribed medication to help them cope with stress, anxiety or depression, according to an online insurance marketplace.

The number of homeless is a fraction of the true, hidden extent of mental illness in America. The homeless have burned their bridges to their family/ friend support system, if they had them, by extreme behaviors.

The Serenity House homeless shelter in Port Angeles was closed after it was so severely damaged by the residents that the organization didn’t have the funds to repair it. The 24-hour public restrooms were similarly trashed. The City Council just appropriated funds to install hardened public restrooms but those will probably be trashed also.

An advocate on the PBS Newshour today said that the answer to the problem is to provide the homeless with homes first. That would put a roof over their heads, but not provide them with food or the substances that so many homeless people poison themselves with. Not to mention that many would destroy the homes.

But the first concern must be to protect the public. Many mentally ill people are incarcerated in prisons. They had to have committed a felony to be sentenced to prison.



wasn’t selling pot a felony? There is too much to unpack there. It also does not need to be true that locking them up is protecting the public.

I know someone who is a paranoid schizophrenic who cannot keep himself on his medication, and bounces around from jail, to halfway, to subsidized housing, in a vicious circle. This is the way in Texas, as there is no way and no where that can handle him 24/7. And that is what needs to happen with people like this. And no, family cannot treat and deal with someone like this.

We had a system for people like this. It was broken. But rather than fix it, some just wanted it ditched entirely. The same people who advocated for that are saying the same thing about “broken” public education. So watch out. We’ve seen this movie before.

Unrelated, what is “L&Ses”?


Lilo & Stitches? Lilo & Stitch - Wikipedia



You can also thank some WWII COs and the “Bedlam 1946” article in Life for uncovering some major abuses.

“Leaders and Statesmen”, my phrase for the corrupt rulers of the Michigan legislature that gerrymandered their way into unassailable control…unassailable until “We The People” amended the state constitution to take redistricting out of their hands, and both houses of the legislature promptly flipped.

We have mentioned before, the concept of “setting up to fail”, the idea of defunding and intentionally mismanaging an operation so it can’t perform it’s job, declare it “broken”, and leverage that “broken” narrative to eliminate or privatize the operation. In Michigan, defunding education has gone hand in hand with a push to privatize education, with the “L&Ses” working closely with their paymasters.