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Opinion Why involuntary mental health treatment isn’t the answer

A homeless person sits on Broadway in Manhattan on Thursday, after New York City Mayor Eric Adams announced a day earlier that homeless people deemed to be in psychiatric crisis can be involuntarily hospitalized. (Andrew Kelly/Reuters)

New York Mayor Eric Adams and California Gov. Gavin Newsom are trying new ways of forcing people who behave violently because of mental illness into hospitalized treatment. Neither approach appears likely to have great impact. But if these flawed plans force a national confrontation with both the limits of involuntary treatment and the consequences of deinstitutionalization, we might start to move toward a mental health system that works for everyone.

This is a difficult subject, not least because it requires us to acknowledge the grave harms done — to others and to themselves — by a small number of people who suffer from mental illness without treating them as though they represent many others who pose no danger.

Those harms are real. Adams (D) had been under pressure to act following a rash of incidents in which New Yorkers were accosted by people who were mentally ill and homeless. In the most high-profile case, an unsuspecting Manhattan subway commuter, Michelle Go, died after Martial Simon, a 61-year-old homeless man who suffers from schizophrenia, allegedly pushed her into the path of an oncoming train.

On Wednesday, Adams announced he will empower police to involuntarily hospitalize people they encounter on the streets whom they deem too ill to care for themselves.

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But if the horror of Go’s death pushed Adams to act, it also illustrates why his approach is likely to fall short.

According to a profile the New York Times published in February, Simon’s lawyer estimated that his client had been hospitalized for his schizophrenia at least 20 times. Those who knew Simon said he often ranted angrily about the hospitals that repeatedly discharged him before he believed he was well enough to function on his own.

As is true of cities across the country, New York has a chronic shortage of psychiatric hospital beds. And even for patients who are fortunate enough to find one, and who do receive treatment, there is a paucity of supportive housing or even follow-up outpatient care once they are discharged. Had Adams’s new program been operative all along, Simon could have been picked up by police, committed to a hospital, stabilized and then released back onto the streets — in what amounted to another spin of the revolving door.

New York Gov. Kathy Hochul (D), who backs the mayor’s plan, has thus far been able to promise just 50 new psychiatric beds. Adams said that “we are going to find a bed for everyone.” If so, the city will need a lot more of them.

Another problem with Adams’s plan is that it burdens police with the new and difficult responsibility of making rapid psychological assessments. It will take months to give police officers and Emergency Medical Services staff the requisite training. And, of course, the time that officers spend on their new mental health duties will not be spent on traditional crime-fighting.

In other words: The plan is ambitious enough to strain those charged with enforcing it, but not likely to be ambitious enough to make a real impact.

Finally, there is the civil liberties issue. There will surely be legal challenges that seek to establish how long individuals can be detained against their will without due process.

In California, Newsom’s approach takes the due process question into account. In September, he signed a law allowing family members, police officers or emergency services personnel to ask a judge to order someone suffering from severe mental illness to submit to a year of involuntary treatment, which can include detention.

The program will begin next year in seven counties — including San Francisco, which has a huge and visible homeless problem — and will be expanded to the rest of the state in 2024.

Officials estimated that the program could get help for roughly 12,000 people — not nearly enough to stem the proliferation of homeless encampments in California’s cities.

Still, both Adams and Newsom (D) should be commended for doing something rather than nothing.

Adams eloquently described “the man standing all day on the street across from the building he was evicted from 25 years ago waiting to be let in; the shadow boxer on the street corner in Midtown, mumbling to himself as he jabs at an invisible adversary; the unresponsive man unable to get off the train at the end of the line without assistance from our mobile crisis team.”

If mass institutionalization warehoused those people out of public view, deinstitutionalization has encouraged us to build our own walls to separate ourselves from our suffering fellow citizens. We walk past such Americans every day, and we pretend not to see their dishevelment, not to hear their incoherence.

The new policies that Adams and Newsom are implementing will not begin to solve our mental health crisis. But their limitations should spur us to do more, and better.