Our co-founder S. Mitra Kalita wrote last week about an incident that galvanized the Bangladeshi community and police accountability advocates around the city: the NYPD killing of 19-year-old Win Rozario, a teen who had apparently called the police during an episode of acute mental distress and was then shot by responding officers when he brandished scissors.
The shooting comes as the public frets about public safety, and grapples with its intersection with mental health. Among the reactions was to wonder whether a more specialized responder could have been dispatched, and what exactly the city is doing to address mental health. This is an issue that I loosely track, and yet I must admit I didn’t know how much of a patchwork NYC’s mental health responder infrastructure is.
I want to first note something about the relation between the concepts of mental health and public safety. These often get spoken about in the same breath or practically interchangeably, and there are some good reasons for that and some risks associated with it. Let’s take subway safety, which has been a consistent preoccupation of the Adams and Hochul administrations, as well as the public writ large. When people say that the subways aren’t safe — and surveys show that significant numbers of New Yorkers feel that way — they are often not really referring to the actual incidence of crime, which remains very low, but to the presence of people experiencing homelessness and mental health issues.
These ideas converge when, for example, someone experiencing some sort of mental episode pushes a bystander onto the tracks or assaults someone. Yet, in the vast majority of cases, when a New Yorker encounters a person with mental health issues on the trains, the latter aren’t engaged in crime per se, nor are necessarily doing anything that puts others at direct risk. Yet the situation itself makes people feel unsafe, and they project that as a measure of crime or disorder.
Even when this contact does stray out into the realm of assault, or another crime, this isn’t really the sort of crime that we would think of as responsive to typical crime-prevention strategies. A surge of cops or National Guard units isn’t going to dissuade someone from engaging in malfeasance if what’s motivating that is a break with reality. The incentives that were presumed to exist in a regular crime avoidance scenario — the calculus of benefit to risk of getting caught and punished, the long-term consequences, the dissuasive power of visible law enforcement, all of which are already the focus of much academic and policy discussion — are all warped here.
Which brings me to the risks, which are that we’re often essentially taking the medicine meant to deal with one problem and hoping it’ll fix another one. To demand that the tough-on-crime template be applied to the mental health problem is to misunderstand causality and not fix either issue. Arresting people with severe mental health problems is not going to functionally do much about crime, and it’s certainly not going to address the issues leading to their supposed criminality. If anything, a stint in Rikers is far more likely to make the issues worse;ot to mention that much of our criminal justice system is predicated on the idea of punitive measures as a response to bad intent, which conceptually breaks down when someone isn’t really capable of exhibiting that intent.
To their credit, policymakers in New York have slowly come around to this understanding, with mental-health specific street and subway teams now being part of the toolbox. So what does this actually look like on the ground? Let’s look at a variety of concurrent efforts, starting with the state’s Safe Option Support (SOS) teams, which Gov. Hochul announced an expansion of as part of her more controversial plan to put the National Guard in subway stations.
The SOS teams feature medical professionals, social workers, and others working mainly to connect homeless and mentally ill individuals in the subways to additional services and permanent housing placements. Mental health treatment is a component, but the teams also prioritize access to basic needs like food, clothing, and public benefits. Separately, the MTA and the state run a program known as subway co-response outreach (SCOUT), which consists of teams of cops and clinicians geared toward acute mental health episodes, with the mandate to potentially take people to forced mental health evaluations if they’re deemed to present a public safety risk.
Separately to that, as of late 2022, city cops and EMS have been empowered to involuntarily hospitalize people considered a danger to themselves or others. These aren’t separate specialized teams, but a policy allowing existing uniformed personnel to receive training to determine whether someone needed to be hospitalized, engendering significant controversy as advocates wondered how these determinations would be made, and whether they were just a shortcut to patrol cops evading due process.
Then there’s B-HEARD, a program intended to send mental health teams rather than cops in response to 911 calls that involve mental health crises. The teams are made of medical professionals and social workers, though sometimes supplemented by police officers when the dispatcher believes there to be some risk of violence. Though launched to much fanfare, recent reports have found that the teams are only responding to a fraction of eligible calls even in the precincts where the program is active, which is still less than half of the total. This would have been the sort of team to respond to Rozario’s distress call, but one was not sent.
The city’s Department of Homeless Services has its own outreach teams, but the more mental-health focused city initiative are the intensive mobile treatment (IMT) teams, run out of the mayor’s Office of Community Mental Health but staffed by partner organizations. The teams have psychiatrists, social workers, and other health professionals who work on streets and subways to do more long-term interventions with people in need of care, prescribing medications and ideally building trust.
This program faced some scrutiny this year after a press report and an audit by Comptroller Brad Lander’s office found that the city was failing to keep track of results, and that many of the people in the program were not meeting with health professionals from treatment teams, taking their medications as prescribed, or being helped into permanent housing. Organizations were often losing track of their clients, some of whom would go on to commit acts of violence. In response, the city and various of the groups involved argued that it was functionally impossible to keep track of everyone, and that where things fell short was often in the unavailability of inpatient treatment when the outpatient efforts were insufficient to stabilize people.
Which raises another point: that even if this hydra of teams and efforts can do meaningful outreach and connect people to mental health resources, those resources themselves are sorely lacking. Just last month, State Comptroller Thomas DiNapoli released a report showing a 23% increase in the number of people served by the state’s public mental health system between 2013 and 2022, coinciding with a 10.5% drop in inpatient psychiatric capacity, or a loss of 990 beds in a similar period. There were only about 4,000 inpatient psychiatric beds available in NYC as of the end of last year, in a city with some 8.4 million people.
So we find ourselves with a system that is hard to even keep in mind all at once, let alone keep accountability metrics on. There are a variety of local and state initiatives with different objectives and authorities, run out of different offices and with different funding streams, and they all operate against the backdrop of a mental health treatment system that has nowhere near the capacity to actually offer recourse to the people brought in.
I don’t have the right answer here, but perhaps it’s worth examining a way to both centralize and expand these efforts such that they are both broadly operative throughout the city, held accountable to sensible metrics, represent a default response to mental health crises as opposed to the use of force and arrest, and are a conduit to more available treatment. Otherwise, we’re just spinning our wheels.
