Mayor's involuntary hospitalization directive raises concerns over resources, accountability

NEW YORK - In New York City, people struggling with severe mental illness, showing signs they are unable to take care of themselves, will now be transported by first responders to a hospital for evaluation, without their consent if needed. 

There is no clear criteria on who this will apply to and city officials say this will be handled on a case by case basis.

However, this new directive by Mayor Eric Adams marks a major shift in how the city approaches mental health. 

"This is really kind of an acknowledgment that there's this very large segment of the population of people with severe mental illness that's untreated," Treatment Advocacy Center Executive Director Lisa Dailey said.

But many are concerned with the lack of resources available to help the number of people who will soon be flooding the system. 

A person transported to a hospital is placed in a psychiatric bed — and those beds throughout the city are severely limited. Many are still offline from the pandemic. But not only does the city need more beds, it also needs the people to staff those beds. 

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"I've spoken with people who said, 'Well, my hospital has these two psychiatric wings and we can only staff one of them because we don't have enough providers,'" said Maya Kaufman, a health care reporter for Crain's New York Business. 

Kaufman recently did a six-month deep dive investigation into the state's mental health system and explained how it has failed at times those with a serious mental illness. Once patients are admitted into a hospital, they can often fall through the cracks before being connected to continuing care.

This is something the mayor is hoping to change by having hospital doctors transfer a patient to an outpatient program before discharging the patient. However, Kaufman said the wait lists for many of these community outpatient programs can take up to a year. 

"This is because we're speaking about really high-intensity programs that are meeting with people multiple times a week," Kaufman said. "They get whole teams of providers, not just one therapist or psychiatrist."

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But going hand in hand with treatment is affordable and supportive housing. Once a person is moved to an outpatient treatment program, they will often need a place to live, which can again backlog the system.

"Involuntary hospitalization can be very traumatic, it can be very upsetting. But if you're going to do that, make use of that," Dailey, of Treatment Advocacy Center, said. "Make sure that the person actually receives treatment, stabilization, and then really invest in making sure that the person is able to succeed when they're ready to be discharged."

Another big detail missing from the mayor's plan is accountability, as Kaufman points out.

City officials have yet to lay out exactly how it plans to report if someone is improperly transferred to a hospital for care and who will be keeping track of this process. 

"We've seen a lot of stories about particularly when law enforcement are involved in interacting with people who have serious mental illness that that can really lead to catastrophe and we've seen people get killed," Kaufman said. "So there's a lot of people wondering how we're going to follow this happening in real time to make sure that people are safe and treated how they should be."

Gov. Kathy Hochul and state lawmakers have also expressed interest in possibly raising the Medicaid reimbursement for these psychiatric beds to make it more profitable for hospitals to keep these beds open and staffed.

This will have to be taken up in the next legislative session starting in January.