Mental health care is broken. Is the police hospitalizing more people the answer?
This is The Marshall Project’s closing arguments newsletter, a weekly deep dive into a key criminal justice issue. Do you want it sent to your inbox? Subscribe to future newsletters here.
In end of novemberNew York City Mayor Eric Adams announced a political controversy that will lead to hospitalizing more mentally ill people against their will. Adams called it a “moral obligation” to ensure treatment for vulnerable New Yorkers, many of whom are homeless and without psychiatric care. Critics said the move gives too much power to the police to stop people, and it’s just a way of sweep away the homeless of the city streets.
adams plan seems to lower the bar for what warrants a psychiatric hold, including anyone with a mental illness who is unable to take care of their basic needs, even if they are not an active threat to themselves or others. Adams, a former police captain, says state law allows for this interpretation. But lawyers for a coalition of civic groups have filed a motion to stop the policy, claiming it violates state mental health law and the Americans with Disabilities Act. The movement is part of a ongoing class action lawsuit on the city’s use of police officers to respond to mental health crises.
Across the country, communities are debating how to fix a broken mental health system and what role involuntary treatment should play. Wrapped up in this debate are growing political fights over public safety and housing, with many politicians and the media equating homelessness with mental illness, and with both violence and crime. Studies show Most people with mental illness are not violent and are much more likely to be victims of crime than the general population.
Some groups are pushing to expand the use of involuntary psychiatric care, saying it can save lives, especially for those whose illness prevents them from accepting treatment. This week, The New York Times profiled a leader of this movement, psychiatrist E. Fuller Torrey of the Treatment Advocacy Center.
But disability rights groups say involuntary treatment tramples civil liberties of people with severe mental illness. Even a brief psychiatric hold can be traumatizing, advocates say, and discourage someone from voluntarily seeking help in the future. Instead, strong community mental health resources can prevent someone from ending up in a crisis.
Other communities are considering tactics similar to Adams’s. In California, Governor Gavin Newsom signed a law this fall ordering more people with schizophrenia and other disorders to receive treatment, or facing guardianship, when someone loses their independence and is assigned a guardian to manage their affairs. Newsom called the law a “new hope for thousands of Californians.” The state disability rights group said it would “unveil decades of progress for people with disabilities.”
The same day that Adams announced his plan, Portland, Oregon, Mayor Ted Wheeler told business leaders that he “supported reassessing the current rules for the involuntary commitment of people with severe mental illness,” according to the oregonian.
There are looming problems for proposals like these. One is the severe national shortage of psychiatric hospital beds. adams He noted that New York Governor Kathy Hochul was creating 50 more psychiatric beds, but added: “We need beds. There’s no way around that.” Critics say 50 more beds are not enough for the current need.
New York City’s community mental health providers, who offer care after someone is discharged from the hospital, are also stretched thin. Adams said patients should not be discharged unless they have follow-up services. But Crain’s New York found that as of mid-November, more than 1,000 New Yorkers are on a waiting list for mental health programs. Hospital systems elsewhere have been criticized for “shipment” psychiatric patients in emergency rooms when there is no long-term care provider to care for them.
Under Adams’ plan, it will often be the police who decide who to bring in for a psychiatric evaluation. Those encounters between officers and people in crisis can easily escalate and end in the use of force, criminal charges, or even death. A research earlier this year by the Washington Post found at least 178 cases across the country between 2019 and 2021 when “wellness checks” or mental health calls ended in a deadly shooting by police.
The data suggests that these policies are likely to disproportionately affect black and brown people. black new yorkers make up 44% of people currently receiving court-ordered treatment under a state law, although they are less than a quarter of the city’s population. Y in Alameda County of California, which includes Oakland, black residents accounted for more than a third of involuntary psychological arrests, but about 10% of the county’s population.
The battle over Adams’s policy continues. Like a New York paramedic put it“Our ambulances are simply the entrance to a broken oil pipeline… We must invest heavily in social services, housing and mental health care if we are to prevent this ongoing tragedy.”