NYC Plan to Hospitalize the Mentally Ill: Risks vs. Benefits

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As part of the city’s efforts to curb street homelessness, New York City has announced a new policy that will significantly alter the criteria for involuntarily hospitalizing New Yorkers experiencing mental health crises. While current legal statutes allow for acute-level psychiatric holds and admissions if an individual poses a danger to themselves and/or others, the new plan authorizes “the removal of a person who appears to be mentally ill and displays an inability to meet basic living needs, even when no recent dangerous act has been observed.”

This move represents one of the boldest steps taken in many years to address the lifelong challenges faced by individuals with serious mental illness: people who, because of the nature of their condition, often lack the capacity and self-awareness to understand their diagnosis, symptoms, and need for treatment. Insight into a person’s own mental illness represents one of the biggest challenges to providing mental health support services and treatment, which we see in my mental health law practice over and over.

This reality is at the heart of an ongoing challenge that makes providing care for such individuals and their loved ones incredibly complicated, particularly from a legal perspective. The balance between an individual’s treatment needs and the potential consequences that come from letting them lapse, along with their fundamental rights to decide, creates a wellspring of issues.

Some of the natural roadblocks to the success of the City’s plan include, but are not limited to:

• The expanded role of law enforcement. The proposed policy empowers police officers to decide who meets the new, expanded criteria for being brought to a psychiatric emergency department and possible involuntary hospitalization. Such determinations are traditionally made by trained and experienced mental health professionals who have spent years working in the field. Providing training to police officers to make these tough calls has already been shown to present challenges. It creates the potential for significant miscalculations and confusion as to the legal standards to be applied and met, and results in actions that have real impacts on people’s lives and are not always in their best interests.
• The misuse of hospital services and facilities. By bringing chronically mentally ill New Yorkers to an acute care facility and an Emergency Department, the plan is placing those who require this critical but non-emergency level of care in an already overburdened setting. A hospital’s role is not to provide treatment for people with chronic conditions when they are not experiencing acute symptoms. Rather, it is designed to stabilize people in crisis and release them, with the discharge supports they need to remain stable in the community. Asking hospitals to go beyond their scope of practice and mission will imperil their ability to help those who do need this level of acute evaluation and care. It will also add to the already immense challenges faced by hospital social workers and other professionals who seek to ensure discharged patients have the necessary supports and follow-up care critical to curbing the “revolving door.”
• The threat of legal action. The lack of legal precedent behind the City’s approach presents a myriad of liability exposures. As a former hospital risk manager, this stands out in large flashing lights to me, from law enforcement to health care personnel and beyond.

Based on my over thirty years of experience as a mental health attorney working with families of loved ones with serious mental illness, substance use disorder, and related mental health issues, I believe the core means of improving our mental health system are: funding outpatient programs, supervised housing, jobs training, treatment support, and oversight and compassion.

Putting money where it is the most cost-effective, not the astronomical rates of an emergency department or inpatient hospital unit, can address a wider number of the chronically mentally ill, many of whom sadly live on the streets of New York City. Giving individuals the dignity of a place to call their home in warmth and safety, and providing mental health professionals and appropriate treatment within those walls, accomplishes many of the long-term goals that mental health advocates, professionals, families, and, most importantly, those afflicted with mental illness, have for themselves and one another.