In November 2022, New York City Mayor Eric Adams launched a sweeping initiative aimed at tackling the twin crises of homelessness and mental health. The initiative, dubbed “Care, Community, Action: A Mental Health Plan for NYC,” empowers officials across the city to commit individuals with serious mental health issues to treatment facilities and hospitals without their consent, even if they do not pose a danger to others. The plan is part of a broader effort to improve public safety and mental health services following a wave of shocking crimes on the subway that have left many New Yorkers on edge.
To address subway safety concerns, Adams also introduced an offshoot program, Subway Co-Response Outreach. Since its rollout last autumn, “SCOUT” has been instrumental in removing at least 113 individuals presumed to be mentally ill from the city’s extensive subway network. Transit authorities report that most of these individuals were voluntarily relocated to shelters. However, nearly one in five detainees required compulsory transportation.
According to the Office of the Mayor, the city’s mental health plan aims to challenge the prevailing misconception that the legal criteria for involuntary intervention necessitate an “overt act” indicating an immediate threat to self or others. Under the mayor’s directive, individuals can be detained if they exhibit signs of untreated mental illness and demonstrate an inability to fulfill their “basic human needs.” This clarification of the legal threshold for involuntary commitment gives city agencies greater discretion in determining whether individuals experiencing psychiatric distress should be taken to the hospital involuntarily.
With homelessness-related deaths on the rise in cities like Los Angeles and Austin, Texas, NYC’s whole-of-government approach is a much-needed intervention on behalf of the nation’s most vulnerable. For far too long, officials have turned a blind eye to the record rates of homelessness nationwide, a crisis so pronounced that it has even drawn the attention of the U.S. Supreme Court. According to a report from the National Alliance to End Homelessness, in 2022 (the most recent year for which data are available), 582,462 individuals, or 18 out of every 10,000 people, were homeless. The 2023 State of Homelessness found that homelessness has been on the rise since 2017, up 6 percent in five years. Now, a groundbreaking study in the journal JAMA Psychiatry reveals that 67 percent of those without shelter have a mental illness.
Despite its success in connecting the mentally ill with vital resources, Adams’ initiative has been met with disdain from some advocacy groups who claim the city has gone too far. Some critics, such as Craig Hughes, a social worker with the organization Safety Net Project, took issue with the mayor’s police-oriented approach to the crisis.
“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.”
While critics are correct that solving decades of dysfunction will require a multi-faceted approach that takes into account other factors — like the role of permanent housing in keeping homeless New Yorkers off the streets — the administration’s plan is at least an essential first step in ending the enduring issue of homelessness among the mentally ill.
Several solutions could quell concerns from all sides about the initiative’s potential for rights violations and arbitrary abuse of power — reminiscent of those experienced during the institutionalization era. One is to establish an independent, third-party oversight committee tasked with monitoring the implementation and enforcement of mental health policies, ensuring that all actions are conducted transparently, ethically, and strictly adhere to individuals’ civil rights.
Another solution is to introduce uniform legislation to guarantee equal treatment for individuals facing commitment proceedings, regardless of location. Ensuring that individuals undergoing civil commitments also enjoy basic courtroom rights akin to those held by criminal defendants –– such as the right to counsel, protection against cruel and unusual punishment, and the right to a just and impartial trial –– will be key in establishing an ethically guided legal system that upholds fairness and justice for all individuals subjected to involuntary commitment processes.
From Mayors John V. Lindsay to Bill de Blasio, New York City leaders have repeatedly –– and persistently — failed to solve the intractable crises of homelessness and mental health. While the Adams administration’s plan still displays vast potential for improvement, it represents a crucial and bold step toward ending the longstanding neglect of America’s most marginalized communities.
