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NYC will involuntarily hospitalize people experiencing homelessness and mental illness
Philadelphia Inquirer - 12/1/2022
Dec. 1—New York City Mayor Eric Adams announced Tuesday a push for police and emergency medical workers to hospitalize people on the streets and subways who have severe, untreated mental illness. Adams said the directive was an effort to curb a recent wave of crimes involving people experiencing homelessness and will allow law enforcement and EMS to involuntarily hospitalize people who pose a danger to themselves, even if they don't pose a risk to others.
"The common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent," Adams said. "Going forward, we will make every effort to assist those who are suffering from mental illness."
According to the New York Times, Adams has prioritized clearing homeless encampments since taking office in January. He said his initiatives are essential to help the city recover from the pandemic and to address perceptions that New York isn't safe. By March, 239 camps were cleared. But only five people from those camps agreed to go to shelters.
Still, the move comes amid national debate surrounding the police's role in encountering people facing mental-health issues. Supporters say the approach will curb crime. Critics fear police will overstep a role better suited for social workers and cause more harm.
How many people are impacted by homelessness and mental illness?
An annual estimate (that is often criticized for undercounting) said about 3,400 people are experiencing unsheltered homelessness in New York. It's not clear how many of them have severe mental illness. It's at least in the "hundreds," the Times reported. The Coalition for the Homeless said that large numbers of homeless New Yorkers who do not live in shelters have a mental illness.
The issue isn't limited to New York. Across the country, officials are grappling with addressing ballooning homeless populations that have only grown since the pandemic.
Precise data is difficult to obtain, but a 2021 point-in-time count by Philadelphia'sOffice of Homeless Services estimated there were about 4,300 people lacking homes in the city, including 700 who were unsheltered. Of sheltered adults, 45.4% reported a mental illness.
According to the Los Angeles Times, a 2019 street survey found that 76% of Los Angeles County people experiencing homelessness were impacted by mental illness, substance abuse, poor health, or physical disability.
Many states — including Connecticut, South Carolina, Georgia, and Texas — have laws allowing involuntary outpatient treatment.
How will the new NYC policy work?
The directive gives outreach workers, EMS, first responders, and law enforcement the ability to involuntarily hospitalize anyone they consider unable to care for themselves. Guidance in the city's published directive on how to determine a person's ability to care for themselves is vague.
The new directive concedes that "case law does not provide extensive guidance regarding removals for mental health evaluations based on short interactions in the field." It goes on to say that if someone has a serious untreated injury, unawareness or delusional misapprehension of surroundings or their own physical condition or health, it may warrant removal.
The mayor announced a phone line where police officers can consult with clinicians. Teams of clinicians and police officers are being deployed to the city's busiest subway stations.
New York officials said the city will train law enforcement, EMS, and other medical personnel to "ensure compassionate care." It's unclear what exactly that entails.
State laws already allow police and medical workers to authorize involuntary hospitalization of people posing the threat of "serious harm" to themselves or others. The mayor's chief counsel told the Times that situations would be assessed on a "case by case" basis.
Adams said that if a homeless person with severe mental illness is hospitalized, hospitals would be directed to keep the patient until they are stable and there is a plan to ensure ongoing care. The mayor added that hospitals will add 50 new psychiatric beds to accommodate the directive.
As noted by the Times, many components of the mayor's plan incorporate heavier use of existing laws. In a statement, New York Gov. Kathy Hochul said the directive builds on work the state and city are already doing.
What are people saying about Adams' plan?
Advocates fighting homelessness say homeless people with mental illness need clinical services and housing.
"If you transport them to the hospital, I'm not sure what services they would receive and if there is no plan for permanent housing they will return to the street and the cycle will continue," Sarah Gillespie, a housing policy researcher with the Urban Institute, told USA Today. She said the directive needs to address housing.
Jumaane Williams, the city's public advocate, praised the directive but noted that many questions remain.
"The mayor's announcement leaves many details unspecified, questions unanswered, and the administration must provide more information on the intentions, implementation, and non-police investment in its plan," Williams said.
Harvey Rosenthal, chief executive of the New York Association of Psychiatric Rehabilitation Services told the Times that the mayor's plan could be counterproductive.
"The mayor talked about a 'trauma-informed approach,' but coercion is itself traumatic," he said.
Others predict the plan could be challenged in court or lead to more harm.
New York City Councilwoman Tiffany Cabán tweeted that the plan was "deeply problematic" and said consent was necessary.
"Often the wrong responder & response is what creates a deadly situation, not the mental health crisis itself," she wrote. "Consent is key & health infrastructure is necessary."
Will Philly adopt Adams' approach?
At the moment, no. A number of Philadelphia departments help people access housing, services and care, "including opportunities for linkages to behavioral health treatment and services," a city spokesperson said.
"The City's social services homeless outreach teams work year-round throughout the city to provide information and services, build trust and relationships, and help people find the housing and solutions that will work best for them," the spokesperson said. "The City remains committed to this approach and will continue to lead with housing and social services, while also working to reduce misconceptions and stigma around homelessness and behavioral health."
Philadelphians, meanwhile, can call the city's outreach team at 215-232-1984 if they see someone experiencing homelessness, or dial 988 if they witness a behavioral health crisis. Crimes and medical emergencies should be directed to 911.
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