Alliance Note: After a year of implementation, Mayor Eric Adams’ plan to address the growing mental health crisis in the city has not made any significant difference in addressing the needs of the community. The general focus on using police to remove people from the street and force them into treatment via involuntary inpatient hospital stays has not led to improved outcomes for people who need support.
This comes as no surprise to those of us who know coercion does not lead to more access but instead creates mistrust in the system and ultimately makes people fear using the system or seeking services. We also know inpatient hospital stays are meant for short term, acute situations and do little to provide the ongoing community support many of us need to maintain recovery.
To truly tackle the mental health crisis in New York City, we must invest in an array of community-based voluntary services, including culturally sensitive engagement programs like the Intensive and Sustained Engagement Teams (INSET) model, peer crisis respites, general peer support services, mental health first responders, Clubhouses, recovery centers, and housing. These are services we all know work but have historically lacked the substantial investment necessary to serve all of us who currently use or are seeking services.
Mayor Adams and his administration must shift their plan away from increasing coercion and instead focus on improving access to affordable housing and increasing the number of voluntary community services we know are effective. Read below to learn more.
Experts Say City is ‘Walking Away’ from Tackling Serious Mental Illness
By Jacqueline Neber | Crain’s New York Business | November 13, 2023
A year after Mayor Eric Adams unveiled his strategy to address serious mental illness, signs of meaningful progress remain scarce.
The plan, which emphasized police involvement and involuntary hospitalization, initially garnered backlash from advocacy organizations. Now, experts say that not much has changed in the city’s mental health landscape. The city says the issue is not an overnight fix but sparse data makes it difficult to gauge if the plan is working.
“Everyone in New York City has a particular need for something: shelter, food, medical services and the like,” said Beth Haroules, the director of disability justice litigation at the New York Civil Liberties Union. “And I think rather than the city being as creative as it can be [in] leveraging the resources that are here, they’re just walking away from everything.”
Incidents where people are pushed onto subway tracks are highly visible reminders of the city’s need to address New Yorkers’ mental health needs. Last month, a 30-year-old woman was left in critical condition after being shoved into a train by an individual who police said was “known to us in the subway system.” Adams never publicly addressed the attack.
According to the NYPD, the number of incidents where individuals are shoved into the subway tracks has declined slightly over recent years. It happened to 30 people in 2021 compared to 29 in 2022. As of Oct. 15 of this year, 15 individuals have been pushed, seven less than for the same period in 2022. The NYPD declined to provide Crain’s with the numbers for years prior to 2021.
A lack of transparency has posed a challenge to the city’s mental health system, which is a patchwork of agencies, nonprofits, law enforcement and hospitals. The complex system creates an environment where no central party is considered accountable for addressing the issue. Kimberly Blair, director of public policy and advocacy at the National Alliance on Mental Illness of New York City said that the success of the plan hinges on the city sharing data with the organizations it relies on to carry out care to these individuals.
“The public needs data. We need transparency as a community-based organization. How are we expected to partner with city agencies if we don’t know the data or the trends? We don’t know how to provide that follow-up care,” she added.
Adams’ plan aimed to address the ongoing crisis of untreated individuals experiencing mental illness who have resisted voluntary assistance but pose a danger to themselves, a small but highly visible population. It included additional training for law enforcement, a hotline staffed by Health + Hospitals clinicians to guide police officers who encounter individuals in psychiatric crisis and a directive to law enforcement and emergency medical responders that involuntary transportation to hospitals for people who appear unable to meet their basic needs falls within their purview.
The directive is the most controversial part of the plan. Last year, advocates’ uproar centered around the idea that the directive could take away individuals’ autonomy by forcing them into treatment. Mental illness-focused groups argued that involuntary hospitalization violated New Yorkers’ rights.
The city did not respond to Crain’s requests for how many involuntary transports or hospitalizations have occurred since the directive went into effect last November but a May report from Politico found that H+H had tallied just 38 involuntary commitments at that time.
Anecdotally, mental health experts say they have not seen a major uptick in involuntary hospitalizations.
Jody Rudin, the chief executive at the Institute for Community Living, said that’s a good thing. When a patient is involuntarily hospitalized, providers have to rebuild their trust which interrupts care, she said. Without hospitalizations, groups can continue providing continuous care such as Assertive Community Treatment, which offers treatment and peer support to people with serious mental illness, and Intensive Mobile Treatment, where teams provide mental health support and medication to people who have recently exhibited unsafe behaviors.
Brian Stettin, the senior advisor on severe mental illness for the Adams administration, emphasized that he doesn’t expect the directive to cause a major shift in the number of people being hospitalized–and that those types of “removals” are relatively rare.
Stettin also said the directive has been a positive “culture shift.” Before, some people who could have benefited from hospitalization weren’t brought in because they weren’t seen as an immediate threat, he said. Now that law enforcement, clinicians and outreach teams have widened their grounds to include people who seem unable to meet their basic needs, the city’s coordinated behavioral health task force has seen removals happen that would not have previously. More people are getting care, he said.
“We have more people with [serious mental illness] who are getting that extended hospital care that they really need to heal, that it really takes to get somebody on a track to get back into the community,” he said.
Communication Hurdles
The plan also took aim at some of the communication barriers between the multitude of organizations that strive to help this population. It included a legislative proposal that would require hospitals to notify known community providers when their clients are admitted or released and collaborate with providers to prepare patients for discharge.
H+H has set up a dedicated email address for each hospital to discuss people involuntarily transported to the facility, Stettin said. When a removal occurs, the hospital has the information the responders share about the person and staff are prepared to meet the patient, according to Stettin. Such communication channels increase the likelihood a patient will be admitted. Admittance allows the hospitals to keep the patient for long enough, prepare them for discharge and connect them with services such as supportive housing.
Historically, information didn’t reach hospital clinicians who made decisions about admitting patients, resulting in a non-admission or quick discharge, Stettin said.
Additionally, hospitals sometimes had little-to-no communication with community providers when their patients were discharged, a practice that has led to disastrous consequences. Without this communication, outreach teams can lose track of their clients only to have them reappear in critical condition in the hospital.
Another tenet of the plan intended to improve communication between parties has seen less success. A hotline that was launched, meant to connect police officers encountering individuals who may be experiencing mental health issues with an H+H clinician, had received zero calls as of July according to the hospital system. H+H did not provide Crain’s with updated data.
Budget Cuts Loom
As the ongoing migrant crisis continues to siphon city resources, budget cuts pose another threat to care for seriously mentally ill New Yorkers. In September Adams requested that agencies submit proposed 5% annual budget cuts by November in an effort to rein in spending as the city takes in upwards of 100,000 migrants. The reductions could be as high as 15%, as the next rounds of cuts would come in January and April.
Such cuts could threaten agencies’ ability to provide care to New York’s most vulnerable populations. Rudin, whose organization has several contracts with the city to operate IMT programs and supportive housing, said the reductions could be “absolutely devastating” for people with serious mental illness if they trickle down to community organizations.
The second phase of Adams’ mental health plan, unveiled in March, focuses on reaching people with serious mental illness before they are in crisis by improving access to care, building out mobile mental health response teams, increasing access to supportive housing and growing capacity at Clubhouses, community facilities where individuals can get support. It is unclear how potential agency-wide cuts could impact the $12 million in new funding for fiscal year 2024 allocated to those initiatives, but advocates agree that shifting to preventative measures could lead to more success.
A Long Road ahead
Going forward, Stettin said the city is focused on legislative priorities such as requiring hospitals to screen psychiatric patients for their need to receive court-ordered care under Kendra’s Law, to ensure more people access treatment.
The city also hopes to restore psychiatric beds at H+H and private hospitals, including those repurposed during the pandemic, and have private hospitals adopt H+H’s communication protocol, he added. However, he said, progress won’t happen immediately and hinges on having community support in place.
“It’s not going to happen overnight,” he said. “We’re trying to reverse decades of systemic neglect. I would ask people to take note that on a small scale, through our coordinated behavioral health task force, we really have made a difference with this culture shift.”