Tough medicine: Adams clears way for city to sweep those in mental health crisis off the streets

As part of his ongoing efforts to get a handle on the city’s sprawling mental health crisis, Mayor Eric Adams on Tuesday issued a directive clarifying that the city’s Health Department (DOHMH) and first responders have legal standing to involuntarily commit individuals with mental health issues to a hospital if they appear to be a danger to themselves “due to an inability to meet their basic needs.”

“A common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent, suicidal, or presenting a risk of imminent harm,” Adams said in a City Hall address unveiling the new directive Tuesday morning. “This myth must be put to rest. Going forward, we will make every effort to assist those who are suffering from mental illness and whose illness is endangering them by preventing them from meeting their basic human needs.”

The mayor said that the city’s clinicians, outreach workers and first responders will continue to try and persuade individuals with apparent mental health issues to seek services voluntarily, before taking action to remove them from city streets and subways against their will. He emphasized the point of the directive is to clarify that state law already allows the city to involuntarily commit people who aren’t meeting their “basic needs.”

“This directive lays out an expedited, step-by-step process for involuntarily transporting a person experiencing a mental health crisis to a hospital for evaluation,” Adams said. “It explicitly states that it is appropriate to use this process when a person refuses voluntary assistance and it appears that they are suffering from mental illness and are a danger to themselves due to an inability to meet their basic needs. We believe this is the first time that a mayoral administration has given this direction on the “basic needs” standard in official guidance.”

In partnership with the state, the city will immediately begin training mental health professionals and first responders on how to conduct these “involuntary removals,” Adams said.

However, in a question and answer session following his address, Adams – along with Deputy Mayor for Health and Human Services Anne Williams-Isom, NYC Health + Hospitals (H+H) CEO Mitchell Katz, his Chief Counsel Brendan McGuire and his Senior Advisor for Severe Mental Illness Brian Stettin – didn’t offer a clear definition of the new “basic needs” standard. Instead, they said a person not being able to meet their basic needs will have to be judged on a “case-by-case” basis.

“It’s a case-by-case determination,” Stettin said. “There are many factors that go into each evaluation. It’s not just about one fact, in a given case, you have to assess the entire set of facts and circumstances. But one of the bases is if they are a threat to themselves by virtue of their inability to care for their basic needs: food, shelter, health care. Those types of things that can become the basis for involuntary commitment.”

The mayor also announced a new hotline staffed by H+H clinicians, who will be available by phone or video call to assist police officers who come across someone they believe to be experiencing a mental health crisis. The hotline will give officers who are unsure if the person in crisis meets the basic needs criteria the ability to describe the circumstances to a trained professional, who will then ideally tell them the best way to handle the situation.

Additionally, Adams said, his administration will deploy teams of clinicians paired with NYPD officers – he’s dubbed “subway clinical co-response teams” – who will patrol the city’s subways to bring those experiencing mental health issues into inpatient care, either voluntarily or involuntarily.

On top of that, the mayor laid out an 11-point mental health legislative wishlist he wants Albany lawmakers to consider when they reconvene for their 2023 session at the start of the new year. That list includes enshrining the city’s new basic needs standard into state law, mandating that clinicians consider a broader range of factors when deciding whether to admit or retain patients with mental health issues and expanding the types of mental health professionals who can involuntarily admit individuals in crisis.

Mixed reaction

But the decision drew mixed reactions from elected officials and even condemnation from organizations such as the Coalition for the Homeless and the New York Civil Liberties Union — the latter of which compared Adams’ directive to a brutish policy “from the failed Giuliani playbook.”

City Public Advocate Jumaane Williams blasted Adams, in an emailed statement, for continuing to put the NYPD on the front lines of handling mental health emergencies.

“The city seems stubbornly insistent on using police as main decision makers in mental health emergencies,” Williams said. “A framework that continues to center overreliance on police, diminishes the role of health professionals, and de-prioritizes the role of peer support will not be sustainable or effective in meeting the needs of New Yorkers in need or a city in crisis.”

Williams, however, gave the mayor his due for implementing some of his office’s mental health recommendations, such as drop-in centers, safe-haven style shelters and stabilization beds.

Jacquelyn Simone, Policy Director at the Coalition for the Homeless, echoed Williams’ concerns that Adams is again putting police at the center of the city’s mental health response, in her own statement. Instead of pursuing a strategy based on involuntary commitment, Simone said, the city should focus on expanding mental health care on a voluntary basis as well as permanent housing.

“Rather than further involving police in mental health responses and urging City workers to involuntarily transport more people to hospitals, the administration should focus on expanding access to voluntary inpatient and outpatient psychiatric care, offering individual hotel rooms to all unsheltered people, and cutting through red tape that has left far too many permanent supportive housing units sitting vacant,” Simone said.

“Mayor Adams needs to focus on repairing our broken mental health system and prioritize bringing access to quality voluntary care and affordable, permanent housing with support services to New Yorkers who need it the most,” she added.