We’ve all experienced it — Someone yelling on the subway platform or aggressively mumbling on the street or demanding money at a park — there are many unhoused people suffering mental illness in New York City, and the number only seemed to grow during the pandemic. Mayor Eric Adams, who has been criticized for his prior efforts to reduce homelessness, said he has a “moral obligation” to help homeless New Yorkers suffering from severe mental illness. Earlier this month he announced a plan to involuntarily remove people with severe mental illness off the city’s streets and put them into treatment. Yet while many New Yorkers are desperate for the city to address the homelessness and mental health crisis, experts believe this approach can potentially do more harm than good.
- Adams’ directive — not policy — will allow for the hospitalization of homeless
New Yorkers who are severely mentally ill if they appear to be a danger to themselves. A person’s inability to care for their basic needs will be defined as a ‘danger to themselves.’
- City agencies, such as the fire, police and health department, will have the legal authority to remove people who refuse assistance, appear to have mental illness and are a danger to themselves.
- New York City, in partnership with the state, will begin training first responders, clinicians and outreach workers to “ensure compassionate care” is provided.
- Unhoused people who are involuntarily removed will be taken to hospitals for evaluation. Hospitals must screen all psychiatric patients before their release.
What will happen after someone is discharged?
The plan fails to clearly address what will happen after someone is discharged from the hospital. A common misconception of the initiative is that unhoused people will be forced into a psychiatric ward — they will not. When involuntarily hospitalized, they will be brought in for evaluation and hospitals will decide who will get admitted.
Anthony Almojera, a lieutenant paramedic with the FDNY Emergency Medical Service (EMS), Vice President of the Uniformed E.M.S. Officers Union, Local 3621 and author of ‘Riding the Lightning, A Year in the Life of a NYC Paramedic’ is the first on the scene when someone calls about an “emotionally disturbed person.” He says the crisis has gotten out of hand. During the last week of November, dispatchers received an average of 425 calls a day for emotionally disturbed persons.
Almojera worries that with the Mayor’s new directive, unhoused people who are struggling with mental illness will not be provided a pathway to healing and recovery. What they need, he said, is help to become medically and psychologically stable, treatment, a social worker who will continue to check in on them and most importantly, secure housing.
“I think it’s ridiculous to expect [people living on the street] to follow up on their role. They’re living on the street and then you discharge them in two days and say ‘Here is a prescription go fill it at a clinic in two weeks — that may not have availability,’” he says. “That’s not going to happen, it’s not happening.”
Understaffed and burned out
Experts also worry that hospitals and medical professionals will not have the capacity to handle the crisis. Adams has acknowledged that New York does not have enough psychiatric beds to accommodate everyone. And while Governor Kathy Hochul said she would allocate 50 more beds, experts say that’s not nearly enough.
“There are only 16 [hospitals that have dedicated emergency departments for psychiatric patients] in the city. You’re most likely going to have these people in the emergency department with all these other patients at a location where there is an overwhelming need and not enough health care workers,” says Maya Kaufman, New York City healthcare reporter. “There’s a shortage of psychiatrists and other professionals who work with psychiatric patients like social workers and other mental health professionals.”
Since the pandemic began, hospitals have been incredibly short staffed, leaving employees overworked and burned out. Almojera says the FDNY EMS team has had several suicides since March 2020 and he’s seen his colleges quit in droves. He thinks the new initiative will only make matters worse.
“There must be an investment in the people who are providing the care. EMS workers are incredibly burned out,” he says. “We’ve hired over 1,200 people to try and replace those who are leaving and we are still short staffed. You can’t only invest in the people who are homeless, you have to invest in the people that are providing the help.”
Trust will be ruined
A major point of contention regarding the Mayor’s plan is the role of police. NYPD officers will have legal authority to remove mentally ill homeless New Yorkers, and many activists are not happy about this decision.
“We’ve already seen the harm that happens to families and individuals when you lock people up because they ‘can’t take care of themselves,’ but that is the role of the government. The role of government is to provide a safety net so that people can live happy lives,” says Anthonine Pierre, executive director of the Brooklyn Movement Center, a member of Communities United for Police Reform. “We want to solve public health problems with public health solutions — not policing.”
The Mayor said first responders will be trained, and a new hotline will also be implemented for police officers to call when deciding whether or not to bring someone to the hospital against their will. However, Almojera worries this will cause conflict between police and healthcare workers.
“It’s always been up to EMS to determine whether that person should go to the hospital or not. We know you’ll have a potential conflict between the two first responders,” he says. “I don’t think cops should be involved in the decision-making process. They should be there as ancillary support. Once EMS decides that this person is violent, then they can help.”
Medical professionals also worry about what this new initiative will mean in terms of the trust between doctor and patient.
“Mayor Adams’ directive represents the opposite of the kind of healthcare that I would like to provide to my patients,” says Shane Solger, a resident physician at Kings County Hospital in Brooklyn, at a rally on Dec. 8. “When patients are forced into hospitals by police simply for being unsheltered, doctors like myself are forced to become an extension of the law rather than healthcare providers….Patients will come to associate us — their doctors — with the NYPD, making it harder for us to build the trust we need to give the high quality of care we strive to provide for all of our patients.”
Will this plan truly keep New Yorkers safe?
Fewer New Yorkers have been taking the subway after an increase of violence against commuters by mentally unstable people. Constant reports of people being pushed into the tracks or attacked on the street plague the minds of city dwellers. Even Adams has said that people with mental illness were largely responsible for increased crime in the subway — but that is not necessarily true. Studies show that the majority of crimes are not committed by homeless New Yorkers or the mentally ill.
“What happens with New Yorkers is that we think ‘Out of sight, out of mind.’ We [think] that if we just drag [homeless people] off the streets without investing in ways of making sure they don’t come back, that they are going to magically never come back,” Almojera says. “That’s not going to happen, they’ll come back. They have come back.”
Pierre believes that we must eliminate the “us versus them” mentality. She thinks the only thing that will provide New Yorkers a sense of safety from homeless New Yorkers who are mentally ill is investing in long-term care and housing.
“Every person on the street with a mental health crisis is somebody’s mother, brother or grandfather. Once we divorce ourselves from people on the street, once it becomes ‘us versus them,’ then we fail to support folks through crisis. It becomes feasible to discard people into these systems,” she says.
Perhaps the most important directive activists are demanding is more funding. People like Pierre believe the Mayor’s plan is simply a bandaid to an open wound.
“The biggest concern is the lack of a comprehensive health care plan for New York City. We are talking about reaching people in crisis but we are not talking about preventative care or follow up care,” she says. “What we actually need is a compassionate care system that is not compassionate in name only, [we need a plan] that brings compassionate care with money. Compassionate care requires money. You can’t just have a heart and care. You have to have a heart and you have to be able to bring these services.”
Council Member Alexa Avilés who represents District 38 that includes Sunset Park, Red Hook, and parts of Greenwood Heights, Borough Park and Windsor Terrace says funding is desperately needed and the Mayor’s directive “sweeps the issue under the rug.”
“We’ve been defunding the mental health system in New York City and New York State for decades. We need funding to create the beds. We need funding for the workers all along the continuum from the first exposure to when people are in institutions and facilities to when they come home. We are asking for real solutions and a comprehensive plan that actually addresses the issue,” she says.
In the meantime Almojera urges New Yorkers to think about the complexities of the plan and, at the same time, be empathetic to the unhoused New Yorkers struggling with mental illness that they may encounter.
“We think that this won’t happen to us. [We think] that there will always be people on the streets and we can hope for the best, we think that they don’t matter as long as we don’t see them every day,” Almojera says. “But we are one paycheck, one familial tragedy away from joining these people.”