Recently, New York City Mayor Eric Adams unveiled a controversial policy to involuntarily remove individuals deemed too mentally ill to care for themselves from the streets, even if they are not a danger to themselves or others. The decision could face legal backlash and came after a series of tragic instances in the city involving individuals with mental health conditions.
While we all share the common goal of keeping our communities safe and providing care to those in need, Adams’ decision is ultimately troubling, and fails to humanely address the root of the problem.
It’s a path that other mayors, including Chicago’s, would be wise to avoid.
For years, community advocates and organizations across the country have fought tirelessly to de-stigmatize mental health so that individuals experiencing crises or symptoms can access the care they deserve in a safe, supportive manner. We know that our communities are safer, stronger and more unified when those in need have access to dignified care.
Adams’ new policy significantly threatens those efforts: It presents the same “solution” to every situation, when care should come in many forms and on different timelines. It prioritizes short-term action that relies on an already-insufficient network of care and has the potential to deeply traumatize vulnerable people. Further, it’s unlikely to increase public safety in any real way.
After our decades of work on this front, we understand why people feel the current system has failed. And with confrontations rising involving individuals on the street, we also deeply understand the pressure to find solutions.
Depending on the condition, living with a mental illness can look very different from person to person. It’s true that some may experience hallucinations or other symptoms that can appear alarming to others. Some people with mental illness may display violence, but not at rates any different from the rest of the population. The most reliable predictor of future violence is a history of violent behavior, not a diagnosis involving mental illness. In fact, people with mental illness are actually more likely to be victims — not perpetrators — of violent crime.
Hospitalizing someone temporarily takes them off the street, but it does not necessarily lead to stabilization. Typically, when someone has fallen through the system of care to this extent, they require longer-term, wrap-around services after being stabilized. Simply putting them in a hospital and discharging them without a support network falls short, when people are in their most acute time of need.
A better approach, like the one we at Thresholds and our partners take in Chicago, is to assist those with a mental health diagnoses to get off the streets by offering access to a holistic set of services. Doing so helps them to end the vicious cycle of homelessness and hospitalization — so they can lead a life of independence.
These services are crucial to keep individuals safe and connected with society. But additional, concrete solutions are needed, including more affordable housing and more funding for evidence-based services like Assertive Community Treatment and mobile crisis response systems.
Teams of providers
Assertive Community Treatment teams include a nurse, psychiatrist, people to help secure housing and entitlements such as Medicaid and Social Security, and professionals to help individuals experiencing homeless set life goals. All of these services are designed to keep people from becoming homeless or entering a hospital again. Without these services, temporary hospitalization turns into a revolving door with the street.
Compare that with Adams’ approach, which is to task police, emergency rooms and hospitals with the responsibility of taking the place of mental health professionals. Police are not mental health workers, and hospitals cannot prepare an individual to live successfully in the community. The nationally recognized best practice today is to move away from a law enforcement response and build a robust continuum of services.
Here in Illinois, the state recently invested $200 million in additional treatment services and is adding mental health crisis responders throughout the state.
Adams’ plan is a grave and misplaced response to recent tragedies. Without follow-through, it will do little to improve the safety and well-being of New Yorkers. Since the advent of COVID, with all we’ve learned about the nuances of mental wellness, we must relentlessly pursue human-centric solutions and cut straight to addressing the root causes of homelessness that exacerbate mental health conditions.
Only then — by bolstering evidence-based, wraparound services focused on long-term recovery and safety — will we begin to see better outcomes for all of us.
Debbie Pavick is chief clinical officer and Mark Ishaug is the chief executive officer of Thresholds.
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