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 The Omnibus Budget Reconciliation Act of 1981 repealed most of the MHSA.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.
Wendy