New York City Mayor Eric Adams announced on Nov. 29 a new pathway forward to addressing what was called the ongoing crisis of people experiencing severe mental illnesses who are left untreated and unsheltered in New York City’s streets and subways. In a public address, Adams detailed what was referenced as a compassionate new vision to tackle the crisis, beginning with a directive issued immediately to city agencies and contractors involved in evaluating and providing care to individuals in psychiatric crisis.

 

The mayor also laid out an 11-point legislative agenda that will be among his top priorities in Albany during the upcoming legislative session. The agenda takes aim at gaps in New York State’s Mental Hygiene Law that he said intensify the City’s challenges in meeting the needs of its most vulnerable residents with severe mental illness. Finally,  Adams announced new clinical co-response teams deployed in New York City’s subways to respond to those with serious mental health issues, as well as an enhanced training in partnership with New York State for all first responders to compassionately care for those in crisis.

 

In accordance with State law and court precedent, Adams’ directive clarifies that outreach workers, city-operated hospitals, and first responders have the legal authority to provide care to New Yorkers when severe mental illness prevents them from meeting their own basic human needs to the extent that they are a danger to themselves. The directive seeks to dispel what was described as a persistent myth that the legal standard for involuntary intervention requires an “overt act” demonstrating that the person is violent, suicidal, or engaging in outrageously dangerous behavior likely to result in imminent harm.

 

Adams also announced that the City is developing a tele-consult line to provide police officers in the field with direct access to clinicians. The new tele-consult line will provide critical clinical advice to police officers when dealing with individuals in distress and ensure a compassionate response for those suffering with untreated serious mental illness.

 

Measures in the new legislative agenda include:

• making the law explicit that a person requires care when their mental illness prevents them from meeting their own basic needs;
• mandating that hospital clinicians consider a range of factors when assessing a patient’s need for involuntary admission or retention, including known treatment history and current ability to adhere to outpatient treatment;
• requiring hospitals to screen all psychiatric patients prior to discharge for their need to receive “assisted outpatient treatment” (court-ordered care under “Kendra’s Law”);
• allowing a broader range of trained mental health professionals to perform evaluations and community removals of individuals in crisis; and
• requiring hospitals to notify known community providers when their clients are admitted or released and collaborate with community providers in preparing patients for discharge.

 

The Adams administration has already begun deploying subway clinical co-response teams, made up of joint patrols of the New York City Department of Health and Mental Hygiene (DOHMH) and the New York City Police Department (NYPD), to patrol high-traffic subway stations to respond with what was called a clinician-led approach to those appearing to have serious mental health issues.

 

Finally, in partnership with New York State, the City will also provide comprehensive training to all clinicians, outreach workers, and first responders to ensure what was called compassionate care that potentially could include involuntary removals when interacting with individuals in distress suffering from severe mental illnesses. The City began rolling out the training immediately.

 

Reacting to the announcement, Deputy mayor for health and human services, Anne Williams-Isom, said, “With this announcement, we are bolstering our strategies to get people who are in danger due to untreated severe mental illness the help they need.” She added,  “We are adding layers of additional support for our first responders to work with clinical specialists in the moment and at the time it is needed, and we are pursuing all other areas for assistance: Health, social services, legal, and legislative. Thank you to our teams across government working to see that this is a coordinated, whole-of-government effort.”

 

Meanwhile, deputy mayor for public safety, Philip Banks III, said, “You can’t effectively have public safety without adequate mental health care — the two go hand-in-hand.” He added, “For too long, public safety personnel’s hands have been tied in getting those in need care before they hurt themselves or others. These directives and proposals are a common-sense way to clear those impediments and get help for those who need it most.”

 

The new approach was also backed by New York City Police Department (NYPD) Commissioner Keechant L. Sewell, who said, “The NYPD works day and night to improve the quality of life of all New Yorkers, especially our city’s most vulnerable populations.” She added, “This is a longstanding and very complex issue. And we will continue to work closely with our many partners to ensure that everyone has access to the services they require. This deserves the full support and attention of our collective efforts.”

 

Since taking office in January, officials from the Adams’ administration say it has made significant investments to address the severe mental health crisis afflicting New Yorkers and connect individuals suffering from untreated severe mental illness to care. In February, Adams rolled out the “Subway Safety Plan” to connect people experiencing homelessness on the subway to shelter. Since that launch, the city has connected more than 3,000 people experiencing homelessness, some of whom are also in mental health crisis, to shelters and safe havens.

 

Adams has also doubled down on investments in community supports for those living with serious mental illnesses, including investing in the expansion of the city’s clubhouse program. Clubhouses follow an evidence-based model of psychiatric rehabilitation according to his administration, and constitute a one-stop treatment facility that helps people with severe mental illnesses through their recovery by providing peer support, access to services, employment and educational opportunities, socialization, and recreation in a safe, restorative, and structured setting.

 

DOHMH is expanding the capacity at some of the most successful clubhouses, with the goal of engaging 500 more members this fiscal year. The Adams administration also launched CONNECT: Continuous Engagement between Community and Clinic Treatment earlier this year as a new model of mental health treatment that focuses on holistic care, including for people experiencing severe mental illness.

 

FDNY commissioner, Laura Kavanagh, New York City Department of Social Services (DSS) commissioner, Gary P. Jenkins, Mitchell Katz, MD, president and CEO, NYC Health + Hospitals (H+H), and Deanna Logan, director at the mayor’s office of criminal justice, were also supportive of the latest announced initiative.

 

Meanwhile, the City’s health commissioner, Dr. Ashwin Vasan, said, “People living with serious mental illness deserve to live their lives with dignity, respect, and free from discrimination and stigma.” He added, “As a city, this work, at the intersection of public safety and mental illness, represents part of the larger strategy, which is centered on providing everyone living with serious mental illness the basic building blocks of recovery: health care, a home, and a community.”

 

He added, “We know that focusing on these pillars will reduce the number of people we see in need on our streets and in our subways to begin with, and is consistent with Mayor Adams’ focus on balancing prevention and intervention. The city is galvanized to address the broader issue of supporting people with serious mental illness to improve health, prevent suffering and isolation, and improve their quality of life. In the coming weeks, we’ll be turning to trusted community groups to inform a comprehensive vision aimed at improving access to care and housing and reducing social isolation.”

 

For her part, Eva Wong, director at the mayor’s office of community mental health (OCMH), said, “We are proud of our cross-agency partnership with the city’s Health Department, Health + Hospitals, NYPD, and FDNY-EMS to develop these new protocols and trainings.” She added, “Helping our fellow New Yorkers most in need get connected to care is a top priority for OCMH. These new protocols and trainings will ensure that agencies and systems responsible for connecting our community members with severe mental illnesses to treatments are working in unison to get them the support they need and deserve. We look forward to continuing our work with city and state agencies as we partner to bring compassionate care to all New Yorkers.”

 

The mayor’s latest approach to tackling the mental health crisis has been met with mixed reviews, with some praising his efforts and some criticizing them, as reported.

 

The full press conference during which the announcement of the new initiative was made can be watched here.