Opinion: Coercion and Institutionalization Won’t Fix NY’s Mental Health Crisis

“We must reject policies that single out, scapegoat, and sweep away the rights of our neighbors with mental illness. “

I spent six weeks in a psychiatric hospital on Long Island in 1970. I hadn’t slept or eaten in many days, had isolated myself for many more, and was increasingly suspicious of others. The medication and “therapy” groups left me empty and gave me little reason for hope. I thought my life as I knew it was lost forever.

Several years later, I went to work at the local state psychiatric center in Albany to try to give encouragement to people like me, who were essentially being told that their lives were over.

I worked as a mental health service provider for the next 18 years and as a mental health advocate for the last 30. I have seen New York’s mental health system at its worst and at its best.

I have seen us fail to provide the time and the will to find out how best to engage people in great need, only to place the blame on them and label them as “non-compliant.”

I’ve seen us give up on people because they wouldn’t accept medications without even trying to first address their most immediate needs, like food, shelter, and clothing. Now I’m seeing the state move to forcibly confine people in psychiatric wards because we haven’t found a way to get them to accept those same things.

I’ve seen people and politicians complain about and decry the “homeless mentally ill” and then fail to provide the specialized housing and supports necessary for people to voluntarily leave the streets and subways for help that they can trust, even as we have 2,500 empty supported housing units in New York City.

I’ve seen us fail time after time to skillfully engage and support BIPOC individuals with serious mental illnesses, as powerfully demonstrated by the finding that nearly 4 out of 5 Kendra’s Law coercive treatment orders are applied to Black and Brown people in New York City.

I’ve seen the sharp rise in public fears about the “violent mentally ill” even as the data is clear that the people I support are 11 times more likely to be victims of violence and five times more likely to be victims of murder.

We must reject policies that single out, scapegoat, and sweep away the rights of our neighbors with mental illness.

But I’m also seeing extraordinarily promising successes.

Just a few days ago, I saw New York’s Legislative Black, Brown, Puerto Rican and Asian Caucus reject the Hochul Administration’s proposal to expand the use of coercive treatment orders in favor of extending more and more appropriate services to those same communities.

I’m seeing programs send peer counselors out again and again to Queens tenements, White Plains bus stations, and Rochester homeless shelters to successfully and voluntarily engage people who would have otherwise been levied with Kendra’s Law orders that are supposed to be used as a last resort, but often aren’t.

I’m seeing the launch of crisis response models in New York State that offer a peer homeless outreach program in New York City, a center offering an array of crisis responses under one roof in Buffalo and the success that forensic peer team members are having in Westchester County.

I’m seeing the success of “low threshold” housing programs that take in and support people who were initially unwilling to stop using drugs or to start taking medications of choice.

Today, after many years of getting the wrong kinds of treatment, I deeply appreciate the medication, therapy, and peer support that I rely on because they were the right fit and introduced in the right way by the right people—and I had the choice to use them.

Years ago, a provider told me of how a worker had gone out again and again to unsuccessfully engage a person in severe need with a particular medication and treatment plan and asked me, shouldn’t we respect people’s right to refuse care? I answered, before you give up, send out someone else and offer them something better.

We must go forward and make these voluntary support and housing models available to all and stop any moves backward to the policies of coercion and institutionalization.

Harvey Rosenthal is CEO of the New York Association of Psychiatric Rehabilitation Services.