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A new policy in New York City makes it easier for homeless people to be forcibly hospitalized


New York City Mayor Eric Adams is trying to make it easier for people who appear to have mental illness to be forcibly taken to the hospital. His new policy, announced last week, directs police officers and street outreach workers to transport someone to the hospital for a psychiatric evaluation if they appear to be unable to meet their own basic needs. That's a shift from the previous standard, which indicated that someone had to pose a threat to themselves or others. Caroline Lewis, a health care reporter with WNYC in New York, has been following this story, and she joins me now. Welcome to the program.


RASCOE: What prompted this change, and who is it supposed to target?

LEWIS: So Mayor Adams has really been on this kick throughout his tenure in office so far of trying to target people who are street homeless or stay in the subways. Obviously, this isn't new. New York City has 60,000 people living in shelters. But it's the people on the street and in the subway who often draw attention to the problem. So he's framed this as a way of helping New Yorkers feel safe.

He's been doing sweeps of homeless encampments. He's been sending teams of clinicians and police officers to do outreach to people in the subways - both offering them services, but also just trying to get them to move somewhere else. And I think part of his focus on addressing serious mental illness was sparked by the death of Michelle Go, a woman who was pushed onto the subway tracks earlier this year by a man who was known to have mental health issues.

RASCOE: What is the legal standard that Adams is citing here? I would imagine there are serious concerns about violating people's civil liberties.

LEWIS: Yeah. Certainly groups that advocate for civil liberties have been some of the harshest critics. But Adams does have some backing from the state on this policy. He pointed to an interpretation of the current law that New York's Office of Mental Health put out in February. And I think we might see some challenges to this new policy once it starts to be implemented. One of my colleagues dug into data showing that the city's Civilian Complaint Review Board already receives hundreds of complaints against the police each year from people who were brought to the hospital against their will.

RASCOE: What about hospital capacity? Are New York hospitals equipped to receive this potential influx of people who may need psychiatric care?

LEWIS: That's one of the biggest issues here. People who work in hospital psychiatric care in New York City say there are many facilities that can't even handle the current patient load. New York has been losing psychiatric hospital beds for years and about 850 of the beds that were shut down to make more room for COVID-19 patients are still offline. About half of those beds were in New York City. Meanwhile, I reported earlier this year on a hospital in Harlem that's part of the public system where staff were dealing with increasing levels of violence from patients, and they attributed that in part to insufficient support staff.

RASCOE: So what is the overall goal here? What is hospital-based psychiatric care supposed to accomplish?

LEWIS: I think this is a point that often gets overlooked. The actual process of being admitted to a hospital and staying on a psych unit can be really traumatic for patients, especially if it's involuntary. Patients are waiting in this chaotic emergency room environment. If they're admitted, they have their clothes, phones and belongings taken away. Sometimes patients are subdued using sedatives or physical restraints if they start to get agitated about something. And in general, the whole ordeal can have very mixed results.

The goal is really just to stabilize people in the short term and then connect them to long-term mental health care and support such as housing in the community. But hospital workers I spoke to said that's not always possible. And a lot of community programs also have waiting lists. These special outreach teams, known as assertive community treatment teams, had an 800-person waiting list as of last month. You know, I spoke to the head of a nonprofit that runs outpatient mental health clinics across the city who said he has a 1,500-person waiting list for a therapist. So I think there is this concern that without more funding, this new policy from Mayor Adams could just create more of a bottleneck.

RASCOE: Reporter Caroline Lewis of WNYC - thank you so much for joining us.

LEWIS: Thanks for having me. Transcript provided by NPR, Copyright NPR.

Ayesha Rascoe is a White House correspondent for NPR. She is currently covering her third presidential administration. Rascoe's White House coverage has included a number of high profile foreign trips, including President Trump's 2019 summit with North Korean leader Kim Jong Un in Hanoi, Vietnam, and President Obama's final NATO summit in Warsaw, Poland in 2016. As a part of the White House team, she's also a regular on the NPR Politics Podcast.
Caroline Lewis