The critiques came swiftly from leading civil liberties workers. “Unless we adequately invest in the long-term health and well-being of New Yorkers facing mental illness and our chronic lack of housing, the current mental health crisis will continue,” a response from Donna Lieberman, the executive director of the New York Civil Liberties Union, read. “The decades-old practice of sweeping deep-seated problems out of public view may play well for the politicians, but the problems will persist—for vulnerable people in desperate need of government services and for New Yorkers,” said Lieberman. Matt Kudish, CEO of the National Alliance of Mental Illness - New York City Metro (NAMI-NYC), echoed these concerns in a statement: “The Administration’s expanded use of Kendra’s Law or assisted outpatient treatment (AOT) to people with SMI [severe mental illness] who ‘cannot meet their basic needs’ is beyond problematic." Kurdish continues, “AOT is a last resort mechanism, not a mental health response. People living with SMI have a right to person-centered and recovery-oriented mental health care. Instead of using the least restrictive approach, we are defaulting to an extreme that takes away basic human rights.”
A highly risky approach to a complicated issue
On Thursday, December 8, NAMI-NYC joined organizations, including Communities United for Police Reform, Housing Works, and Correct Crisis Intervention Today (CCIT-NYC). New York is not the only place enforcing such policies with mixed reviews and results. Recently, three hospital systems sued Oregon state after people with mental illness were left in their care instead of moving them to long-term care. These individuals had been deemed a danger to themselves or others when admitted. “Sometimes people are truly a danger to themselves—either in terms of active risk like suicide, or in terms of not meeting their basic survival needs, like not eating—or a danger to others, and hospitalization, with or without consent, is the only appropriate and ethical treatment,” says Dr. Irene Hurford, a psychiatrist, and director of Clinical Programs at One Mind. As of September 2022, there were 60,252 homeless people in New York City. The policy sets forth training police officers to identify who needs mental health care. Hurford calls this quick guidance and power to make these life-changing decisions a “recipe for violating human rights” and a potential for traumatizing impacted individuals. Dr. Zishan Khan, a psychiatrist with Mindpath Health, points to a myriad of issues that can arise. People may not willingly want to leave, especially if they have delusions about being taken or have witnessed other individuals being involuntarily committed. Tension and even violence can occur—a combination further heightened by police officers carrying loaded guns. Since 2015, in one in five instances of an on-duty police officer shooting and killing someone, the victim had a mental illness, according to a database managed by The Washington Post.
Expanded access to housing is essential
There is the compounded issue of an overwhelmed hospital system and a tremendous lack of affordable housing in New York City. Affordable apartments (or what affordable means in New York City) are rare. The vacancy rate for apartments under $900 is 0.86%, according to the 2021 Housing and Vacancy survey. In contrast, the survey found 12.64% of apartments $2,300 and up to be vacant. Mental health professionals across New York City have spoken out about the lack of psychiatric beds and staff to care for patients. Experts agree: Creating more accessible (both in affordability and safety) housing and healthcare is a critical path forward. “Without addressing the underlying housing problem and the lack of access to appropriate healthcare, we are simply perpetuating the problem,” says Khan. “Mayor Adams has advanced a Housing First model, but at this time, it will only provide housing to a small minority of the homeless in New York City,” adds Hurford. “If the Mayor is serious about helping the homeless of New York City get housing, he will expand the use of an evidence-based model to deliver housing and mental health services to New York City’s homeless population.”
