Opinion: Mayor Adams' Reforms Are Stuck in the Past

The New York Times front-page story about psychiatrist E. Fuller Torrey provides a useful framework for understanding the gist of Mayor Eric Adams’ directives to have police take homeless people to hospitals, involuntarily if need be. For decades, Torrey has spun a narrative linking random violence to a category he coined as people with “untreated” mental illness. On November 29^th, when Adams unveiled his proposal, he, too, referenced the dubious category "untreated." Adams also supports a signature Torrey priority, involuntary outpatient commitment, and hopes to expand it to become part of the planning process for people being discharged from in-patient hospitals. As does Torrey, when describing homeless people who were mentally ill, the potential for violence permeated Adams’ remarks. Adams ended his bold and controversial proposals by saying that helping people with mental illness protects “the rights of every New Yorker to live, work, thrive, and be safe.”

Linking Adams and Torrey is Brian Stettin, who joined the mayor’s team in July as Senior Advisor For Severe Mental Illness. Stettin is a lawyer, not a health professional, and he came from Torrey’s Treatment Advocacy Center (TAC), in Washington, D.C., where, as policy director, he worked to help states secure formidable commitment laws. Stettin had previously drafted New York State’s Kendra’s Law for involuntary treatment, which was named after a woman who had been pushed to her death in 1999 by a man, Andrew Goldstein, with a history of mental illness. Kendra's Law aligned with TAC’s ambition for compelling community services on people called “untreated.” It is difficult to untangle the irony that Kendra's Law was signed by Gov. George Pataki, who, six years before, had cut community services and starved the 1993 reinvestment law his predecessor, Mario L. Cuomo, signed funding them.

Many of the policies—and some of the exact phrases—now coming from Adams’ lips can be attributed to Stettin, based on his 2013 op-ed in the Daily News, “NY’s true mental health problem.” Stettin parses self-harm, practically making it synonymous with homeless people, as did Adams when outlining why police should remove people even if they presented no conspicuous symptoms. Stettin writes, “The person[s] who cannot meet his basic needs for food, clothing or shelter, and the person unable to seek treatment necessary to prevent potentially irreversible damage to his brain, are also dangerous to themselves in a very real sense.” His preoccupation with the risk for violence based on mental illness leads him to call for "reducing the prevalence of untreated severe mental illness." It served as preamble for Adams a decade later.

Adams’ plan dates from campaigns waged by Torrey with Donald “DJ” Jaffe in the 1990s. Weary from pleading for services on moral or health grounds, and also with a marketing and public relations background, Jaffe explained to New York City families that, “From a marketing standpoint, it may be necessary to capitalize on the fear of violence.” To get services, they would scare ordinary citizens. They could drive fear to get results. This they did by publicizing random, statistically rare events as if they were a common occurrence. They built an archive of “preventable tragedies” about horribly sad, infrequent, but gruesome events. Soon they were pitching the bogus headline that people with untreated mental illness were responsible for 1,000 homicides a year. These became their strategies to pass laws similar to Kendra’s Law nationwide.

Hiding in Plain Sight

The 1990s is now thirty years ago, and New York City's mayor today should not rely on the past. Nor should he link two separate problems—housing for people who are homeless, and building services for people with mental illness. It also appears Adams has ignored a 2019 forward-looking blueprint for reform coming from New York City’s Public Advocate, Jumaane Williams. Williams discusses evidence-based programs minimizing police as well as hospital-based interventions. He emphasizes: “respite centers, drop-in centers, mental health urgent care centers, and safe havens.” He also said: “hire peers,” people with lived experience; seek alternatives to 911 police calls. Both are emblematic of the FCC’s new mobile suicide and crisis lifeline, 988, operational since last July.

As of 2022, according to a follow-up report, the city has not met its goals. While heaping blame on de Blasio, Williams seems to be waiting for Adams to deliver. In the meantime, yellow flags abound: Respite beds have declined and mobile crisis teams have gone down from 24 to 19. NYC has still not completed the training of law enforcement in state-of-the-art crisis intervention (CIT), a three-decades-old program implemented across the country and credited with saving lives. While these might be part of Adams’ future plans for a care continuum, right now it seems coercion outpaces practical alternatives with an emphasis on filling psychiatric beds with homeless people.

Nobody doubts the problem is urgent. But Adams' recommendations are not moving toward a solution. He should return to the drawing board with a freshness of vision informed by the vast number of responses to his proposals, including those of his critics, and answer basic questions looking forward, not yoked to the past.