Are There Answers to Mental Illness?

On the latest decision out of New York City

Mayor Eric Adams cannot solve, in a single year, New York’s various crosscurrent crises. Homelessness, festering for decades, plagues the deeply unaffordable city. Shootings and murders have decreased, but other kinds of crime—robberies, burglaries, grand larcenies—all remain significantly elevated from a year ago. Adams ran on containing this kind of crime; he has both rightly spoken to the fears of working-class people who have to contend with violence on the subway or the threat of a gang, but he has fear-mongered too, claiming at various points this crime is the worst he’s ever seen, as if 2,000 murders a year are on tap again, as they were in the early 1990s.

The city is still climbing back from the depths of the pandemic. Nightlife is restored, and so is plenty of outer borough business. Midtown remains crippled from a shift in commuting patterns that is probably permanent. The MTA will soon face a fiscal crisis as ridership numbers fail to hit their 2019 peak.

New York is not a dire place. But it is in a somewhat peculiar moment, and a new generation of people must acquaint themselves with the idea of random violence, the most unsettling kind. I personally do not have any fear; I’m a somewhat young male, and I assume I won’t be a victim of a hate crime. Still, we New Yorkers all glance around a little more these days, wondering if an unhinged person will leap out from behind a pillar and knock us to the subway tracks or, for no reason at all, punch or stab us. Adams announced this week a new, highly controversial push to remove people with severe, untreated mental illness from the city’s streets and subways. It should be stated, outright, that many homeless people do not commit crimes and mental illness is not a prerequisite to criminal behavior.

What Adams is attempting to do is radically alter a paradigm: instead of involuntarily hospitalizing people who pose a threat to others, the city will also target mentally ill people on the street who appear to be a danger to themselves. “The common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent,” Adams said at City Hall. “Going forward, we will make every effort to assist those who are suffering from mental illness.” The city plans to roll out training immediately to police officers, Emergency Medical Services staff and other medical personnel to “ensure compassionate care,” though the city’s new directive on the policy acknowledges that “case law does not provide extensive guidance regarding removals for mental health evaluations based on short interactions in the field.”

What is going to be done, exactly?

Many on the left are rightfully concerned that Adams has just further emboldened heavily armed police, never the most equipped to handle mental health distress calls, to violently sweep people from the streets. Tiffany Cabán, the socialist city councilwoman from Queens, tweeted that “consent is key” and called Adams’ announcement “deeply problematic.” Other medical professionals pointed to the reality that emergency rooms are already overwhelmed and understaffed. There simply aren’t enough beds, and promised supplemental resources never arrive. It’s easy to see this policy leading to clogged ER rooms and little else, as mental health patients cycle into and out of police custody. Confrontations may grow violent. In 2016, an NYPD sergeant killed an elderly woman suffering from schizophrenia, and it’s not hard to imagine the scenario playing out again, as skittish police opt for their weapons to subdue a person in the grips of psychosis.

One element of the opposition to the new city policy is steeped in unreality or at least a misunderstanding of certain crises. Cabán’s invocation of “consent” is popular in progressive and advocacy circles, and is compelling in its direct morality. None of us should be detained against our will. We do not want to live in a police state. If you are reading these words with any degree of coherence, you agree with Cabán, because you are in the right mind to do so. But what if you aren’t? What if you believe, in the next five minutes, you absolutely have to kill yourself? What if you stopped taking prescribed psychiatric medication a month ago, two months ago, one year ago? What if you spend your days and nights screaming from a sidewalk or a bridge? What if you are convinced there is an international conspiracy against you or, in the words of one writer who speaks eloquently about his own bouts with mental illness, you start to think an ex-girlfriend is putting shards of glass in your cereal and you must violently exact vengeance?

This is where ideology gives away to the ugliness of the human mind. Talk therapy and good vibes can only go so far for those who need regular medication to move through their days without killing themselves or others. “My mental state is being taken care of because it’s well-medicated; I try to keep it in control and don’t let it control me,” one homeless woman told the New York Times. As a Black woman, she said she feared Adams’ new policy because she didn’t want more dangerous encounters with police, but defended the idea of being forced into mental health treatment. She said police had, three times, taken her off the street and involuntarily committed her to a psychiatric ward. “The stigma is that psych wards are bad,” she said. “They are not. They care.” Everyone will have their own experiences; some are miserable in mental health facilities and believe they shouldn’t be there. Many psychiatric wards of the twentieth century were inhumane. The movement of shutter most of them was well-intentioned, if ultimately disastrous. We are picking through the ruins of decisions made decades ago.

The state government must do far more to make this city policy workable. In the long run, new psychiatric facilities must be built to replace all those lost decades ago. There are people who can live much happier and safer lives in group homes; the alternative is almost always the street, where nights can be hellish. Can the city and state rapidly add new psychiatric beds? Given the sclerotic nature of New York government, it’s unlikely, but the governor and mayor will have to summon some ingenuity. The funds can be found. If Congress will never step up to create single-payer or nationalized insurance that anyone can access, New York lawmakers should take seriously the task of making mental health care deeply affordable. Many psychiatrists refuse Medicaid and medication itself can be extremely expensive. Deteriorating mental illness ends at the emergency room, and a wealthy, functioning society shouldn’t be treating people there. As always, there are no easy answers. Unwinding decades of failure will take more than one directive from one mayor.