The mayor issued a directive to the NYPD, emergency medical services and the Department of Health and Mental Hygiene empowering them to “involuntarily transport” people experiencing acute mental health crises to hospitals, even if they do not present an immediate threat to themselves or others. But it remains unclear where they will go for continued assistance and housing after they are discharged.

Mayor Eric Adams on Tuesday announced a new effort to forcibly remove people experiencing acute mental health crises from the streets and subways and transport them to hospitals for involuntary evaluation—though it remains unclear where they will go for continued assistance and housing after they are discharged.

The crackdown comes as cold temperatures drive more unsheltered New Yorkers into subway cars and stations and marks the latest phase of Adams’ police-oriented approach to visible homelessness. He has issued a directive ordering the NYPD, emergency medical services (EMS) and the Department of Health and Mental Hygiene (DOHMH) to take an expansive view of state law that allows for “involuntary removal” of people, even if the individual does not present an immediate threat to others.

Adams said police and other city workers can now determine that a person should be detained for evaluation and transported to municipal hospitals if they decline “voluntary assistance and it appears that they are suffering from mental illness and are a danger to themselves due to an inability to meet their basic needs.” EMS will transport the individuals and, once there, Adams said, they will be evaluated by a clinician, potentially admitted and perhaps ordered to receive “assisted outpatient treatment” (AOT), commonly known as Kendra’s Law.

“If severe mental illness is causing someone to be unsheltered and a danger to themselves, we have a moral obligation to help them get the treatment that they need,” Adams said in a prepared speech Tuesday.

But with the DHS shelter population at a record-high, people who are discharged from hospitals—if they are even admitted in the first place—may end up right back on the street or subway, warn civil rights groups and advocates for the homeless.

“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 New York Civil Liberties Union Executive Director Donna Lieberman, who called the plan “a page from the failed Giuliani playbook.”

Permanent housing is considered key to promoting stable health, or at least providing a personal space for people who might otherwise sit in a park or subway car during a mental health crisis. But initiatives to improve options for people who have chosen to bed down in public spaces rather than the DHS shelter system have had mixed results, while moves from shelters to permanent housing have slowed.

Early in the year, Adams touted an initiative to open hundreds of beds in new stabilization and SafeHaven shelters—specialized facilities geared to street homeless New Yorkers that do not have a curfew and that feature on-site services. DHS said they have so far this year opened around 700 new SafeHaven and so-called stabilization beds, which are similarly geared to street homeless New Yorkers, but do not require the same level of on-site services as SafeHavens.

The number of people staying in the Department of Homeless Services’ (DHS) SafeHaven beds has remained virtually unchanged since early-May, hovering around 1,500, according to daily census data published by DHS and tracked by City Limits. DHS does not publicly report stabilization bed numbers, but has shared information in response to records requests. There were 734 people in stabilization beds as of March 1, according to the most recent data provided. The agency did not share the total number of current stabilization beds, but said there are about 3,400 specialized beds tailored to street homeless New Yorkers. 

Many New Yorkers staying on the street have opted against entering the specialized shelters, even after repeated and aggressive sweeps of their encampments. An estimated 3,439 people were unsheltered in January 2022, according to the city’s most recent HOPE Survey, an increase from the year before, though advocates say those numbers are usually an undercount. Adams said Tuesday that street homelessness alone was not grounds for involuntary removal to a hospital.

Some of the specialized facilities have been canceled or have closed in recent months. In August, the city abruptly changed a plan to open a SafeHaven on the Upper East Side after nixing two planned sites in Chinatown earlier in the year after pushback from neighbors. DHS said the agency has opened several other locations, including at least two so-called Welcome Centers—temporary units for people moving off the streets who are then referred to other shelters—and has the ability to open new sites quickly.

There is also another, permanent option under the city’s control: Nearly 2,600 supportive housing units were vacant last month, the New York Times reported. The apartments are reserved for people experiencing mental illness and are located in buildings with on-site case management and treatment services. Bureaucratic delays and providers’ leeway to reject applicants have left apartments empty, while DHS said many of the vacancies are the result of typical move-outs or are in new units that have not yet leased up.

Despite launching a modest pilot program to move up to 80 street homeless New Yorkers into supportive housing in September, Adams said earlier this month that the city does not plan to bring that kind of “Housing First” model to scale.  

On Tuesday, he acknowledged the churn from hospitals back to the streets, but called for an incremental approach to housing.

“You can’t just stabilize people for a few days and send them back out into the city,” Adams said. “We must build a continuum that helps patients transition into step-down programs and eventually into supportive housing.”

“Nobody should think decades of dysfunction can be changed overnight,” he added.

An expansive view of mental health law

Adams’ broad interpretation of state mental health law to allow for more involuntary removals to hospitals echoes a memo issued by the state’s Office of Mental Health earlier this year. 

About 44 percent of the New York City residents under court order were Black, while 32 percent were Latino, according to the state data. More than two-thirds were men.

New York law, Adams said, “explicitly states that it is appropriate to use this process” if a person does not seem to be addressing their own basic needs. Typically, people are only forcibly removed to the hospital if they pose an immediate threat to themselves or others. 

Use of court-ordered AOT—Kendra’s Law—has increased over the past year, according to daily reports issued by the state. There were 1,641 people in New York City  under AOT court order as of Nov. 29—up from 1,397 on the same day last year, but nearly the same as on Nov. 29, 2018, when there were 1,624.

But Adams’ directive issued Monday acknowledges that “case law does not provide extensive guidance regarding removals for mental health evaluations based on short interactions in the field.” But, the order continued, “serious untreated physical injury, unawareness or delusional misapprehension of surroundings, or unawareness or delusional misapprehension of physical condition or health” could all be considered justification for forced removal to a hospital.

Adams on Tuesday also outlined a state legislative agenda that would make it easier to transport people exhibiting signs of mental illness to hospitals and mandate that hospitals make efforts to inform the psychiatric patients’ “community providers,” such as homeless shelter staff, about their care. 

Not everyone experiencing acute mental health crises is homeless, though Adams honed in on the relatively small, but visible, population of street homeless New Yorkers in his speech and in a press conference.

Since taking office Jan. 1, Adams has ordered a surge of cops below ground on multiple occasions and put police in charge of homeless encampment sweeps. An uptick in crime and a handful of high-profile attacks in the subway system, including some crimes committed by people experiencing homelessness—as in the case of the January pushing death of 40-year-old Michelle Go—have fueled perceptions of danger. Advocates point out that people experiencing street homelessness are far more likely to be victims of violent crime than perpetrators. Go’s alleged assailant had been in and out of hospitals and outpatient programs, becoming a symbol of the city and state’s broken system for mental health treatment. 

The city’s dwindling hospital psychiatric units frequently discharge patients with mental illness quickly, or refuse to admit them at all, a September investigation by Crain’s revealed. More than 800 psychiatric beds converted to treat COVID patients remain out of use, including about 415 in New York City, Gotham Gazette reported Monday. 

Intensive Mobile Treatment (IMT) and Assertive Community Treatment (ACT) teams—social service and mental health providers that visit regularly with clients and administer medication outside an institutional setting—provide key support, but are stretched thin, Crain’s found. Adams said state law “should require hospital evaluators to consider not just how the person is acting at the moment of evaluation but also their treatment history, recent behavior in the community, and whether they are ready to adhere to outpatient treatment” before they are released. 

The forced removal plan received support from conservative lawmakers, including Queens Councilmember Robert Holden, who characterized some people with serious mental illness as “ticking time bombs.”

“Let’s get these New Yorkers the help they desperately need and deserve and make our streets and subways safer for all,” Holden said. 

But another Queens councilmember, Tiffany Cabán, sharply criticized the plan, saying it will lead to more interactions with police that could escalate to violence.

“This is deeply problematic,” Cabán tweeted Tuesday. “I’ve visited trained, dedicated professional mental health first responders across the US. They consistently point out a couple of truths. Often the wrong responder & response is what creates a deadly situation, not the mental health crisis itself.”

In a statement, the Coalition for the Homeless took aim at a specific element of Adams’ plan. The mayor said people with mental illness in shelters will be enrolled in special Medicaid-managed long-term care plans that will provide them with more access to psychiatric treatment. The Coalition countered that just 2.3 percent of the 93,925 adults eligible to receive enhanced mental health services under the state’s Medicaid managed care program for people with serious mental illnesses have actually received that care.

“Mayor Adams’ call for enrolling more people in shelters in Medicaid is not a real solution,” the organization said. 

They urged Adams to prioritize housing over policing for real long-term solutions to homelessness and serious mental illness, including expanding access to voluntary inpatient and outpatient psychiatric care, offering individual hotel rooms to all unsheltered people and streamlining moves into empty supportive housing units.

Craig Hughes, a social worker with the organization Safety Net Project, said the involuntary hospitalization directive is the latest example of Adams defaulting to a police-first approach to complex social issues.

“He is unfortunately seeing through the lens of policing a way to solve a housing crisis,” Hughes said. “And we know from decades of homelessness policy that will just criminalize people and leave people churning through the institutional circuit of jail, hospitals and back.”