Is Indefinite Involuntary Commitment of Unhoused Mentally Ill the Solution?

The recent announcement of the plan by New York City Mayor Eric Adams to begin involuntarily hospitalizing unhoused people deemed in “psychiatric crisis” is facing wide-scale resistance from mental health experts and patient advocacy organizations. Many feel the plan is ill-founded, dangerous, and unmedical in its scope.

Announced in late November 2022, the initiative crosses numerous boundaries. One of the most jarring changes in its approach to mental health is the stated goal to involuntarily hospitalize citizens even in the absence of a clear danger to others. This would mark a radical shift in mental health care.

All 50 states have standards and procedures for involuntary commitment, which are typically characterized by limiting such treatment to people who are deemed to pose some risk of harm to themselves or others due to mental illness.¹ Most state laws also clearly describe a limited duration of stay, commitment process, and grounds for such commitment and often require exploring possible outpatient commitment options. Outpatient commitment, also called involuntary outpatient commitment, offers patients an opportunity for intensive and mandatory outpatient treatment, requiring the patient to be willing to engage in such mental health care.

The New York Civil Liberties Union (NYCLU) has actively and firmly opposed Mayor Adams’ initiative and its focus on expanding the current ability of New York authorities, including police and firepersons, to hospitalize patients without their consent. “The Mayor is playing fast and loose with the legal rights of New Yorkers and is not dedicating the resources necessary to address the mental health crises that affect our communities. The federal and state constitutions impose strict limits on the government’s ability to detain people experiencing mental illness — limits that the Mayor’s proposed expansion is likely to violate. Forcing people into treatment is a failed strategy for connecting people to long-term treatment and care,” according to NYCLU Executive Director Donna Lieberman.  

Critics have voiced strong concerns about the plan criminalizing homelessness and mental illness and particularly about the use of police officers to identify and assess which persons should be involuntarily incarcerated, according to local news coverage.  

Mental health and civil rights advocates filed a temporary restraining order and, on December 12, 2022, a federal judge took no action on the concerns and postponed a decision. The request for the temporary stay was filed as part of an ongoing lawsuit filed last year on behalf of Steven Greene and others who’ve been detained against their will by police in the last few years for psychiatric reasons, according to a news article in The City. In one dramatic example, Peggy Herrera called 911 seeking help when her 21-year-old son, Justin Baerga, was having a mental health crisis. She specifically asked the dispatcher to send emergency medical technicians (EMTs) and not the police. Instead, several number of cops responded and “Herrera wound up handcuffed and arrested while Baerga was beaten, handcuffed, and brought to a nearby hospital psychiatric ward.”

The New York City government has not offered viable or even clear proposals to make needed and massive improvements in infrastructure, housing, and mental health facilities, or to address the current shortage of mental health workers in New York City. To date, Mayor Adams’ solutions to these problems have been limited to general homilies, including his less-than-encouraging comments noting “we’re going to staff up to those needs.” He added: “I think it’s a powerful tool to FaceTime a clinical professional … We’re going to continue to staff up with psychiatric professionals. We’re going to lean into telemedicine.”

It’s hard to imagine how such a plan could work in a city where a large gap exists between mental health needs and mental health resources. The FaceTime quote aside, this plan feels doomed, which is probably a good thing for those who care about the rights of those citizens caught in the known overlap of homelessness, poverty, social injustice, addiction, and severe mental illness.

Even if the new plan in New York City is given the green light by the federal judge, the vast lag in infrastructure needs makes it seem extremely unlikely that such an under-resourced plan could survive. Just as mental health, homeless, and substance use disorder patient advocates have been hollering for years, we don’t need more police incarceration; we need a brand new mental health system with the accompanying resources required to make it work once and for all for our friends, family, and loved ones, those who so desperately need and deserve it.

This article originally appeared on Clinical Advisor