In California, Governor Gavin Newsom recently signed a law that makes it easier to make mandatory treatment of people with certain mental illnesses easier. The mayor of Portland, Ore., said last week that he was considering similar measures. And in New York City, Mayor Eric Adams is continuing push for involuntary hospitalization prompted weeks of public debate.
All three leaders, like others around the country, are facing the same sensitive challenge: how to manage and treat people with severe mental illness living on the streets and trains. subway, people who refuse to take drugs. The group represents one of the most intractable and visible subsets of the homelessness crisis in America.
The origins of that crisis can be traced back to the de-institutionalization movement in the middle of the last century, when the struggle for citizenship and hopes for new treatments led to the closure of hospitals. Public psychiatry has existed for decades. Many people with schizophrenia and other disorders have been released. Over time, they experience difficulties, in part due to inadequate provision of housing and supportive care services. Nationwide, thousands or more people have lived on the streets or cycled through makeshift shelters, prisons and emergency rooms; some become a threat to themselves or others.
Their plight has become even more acute in recent times. Disruptions related to the Covid pandemic, rapidly rising costs of living, and unstable public funding for mental health treatment have Homelessness worsens in all its forms. And some politicians have blamed mentally unstable people for an increase in certain types of crime.
There is no clearer example than New York City, which is the focus of today’s news. The full effect of Adams’ suggestions may take years to understand. But the debate they have sparked — including opposition from unexpected places — helps illustrate what is at stake.
New York’s plan
The city’s program is designed to help a small segment of the homeless population: a group of at least hundreds of people known to have untreated mental illness so severe that they are unable to respond. their basic needs. (My colleague explained it details here.) In an address announcing the change, Adams said the city has a “moral obligation” to intervene.
Adams’ critics are quick to point out that he is battling worries about another issue – crime. He has said that people with “mental health problems” are increasing crime on the subway, although researchers say only a small percentage of serious crime can be attributed to illness. mental.
The city has long been able to send members of a smaller group of severely mentally ill people to the hospital for care. Adams directed police officers and other city employees to make the practice more common — not only among those who became violent, but also among those deemed to be in a state of affairs. an acute mental crisis threatens their safety.
The Adams administration hopes that its policy will help stabilize those who are in dire need of it. It also wants hospitals to take those patients in until an outpatient care plan is in place.
widespread opposition
Adams’ plan immediately caused a storm of criticism. Some warn that the practice could hurt already unstable individuals or threaten their civil liberties. Others point out that New York severely lacks the psychiatric beds and supportive housing needed for treatment plans. Even Adams admits recent steps are just the beginning of trying to regulate a complex system.
But almost as remarkable as the criticism are the critics themselves. Liberal politicians and nonprofit groups geared toward the homeless community have sounded the alarm, and so have New York’s influential police community with which groups often disagree.
Years of intense public outcry around the way the police treat civilians, inflation and relatively low wages have dampened morale and created a growing shortage in the ranks of the Police Department. New York. Patrick J. Lynch, president of New York’s major police union, said the new policy would put “strain on our understaffed, overworked and underpaid ranks.”
There is another pressing question: Should police officers be the ones to interact with a severely mentally ill person on the street? Officers are not trained to be medical professionals, and encounters with people with emotional disturbances can escalate quickly.
Kim Hopper, a Columbia University professor who has spent decades focusing on the relationship of homelessness and mental illness in New York, raised other concerns. He said Adams’ new initiative is a repeat of mental health efforts that failed a generation ago. He said he worries that city policy will simply shuffle people through emergency rooms, shelters and streets without addressing structural issues like lack of housing and funding. support programs.
“It’s the same trap, but it’s offered as a new compassion,” he told me. “We know, and they know, this won’t work.”
Related: Some Black Leaders in New York Compare Adams’s criticisms to the experience of the city’s first Black mayor, David Dinkins.
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