New York City Needs Comprehensive Approach 
to Address Mental Health Crisis

New York City Mayor Eric Adams recently announced a new plan to provide care for untreated individuals suffering from serious and persistent mental illness who are unable to care for themselves, including assessment, emergency transport and involuntary commitment. While the New York State Psychiatric Association (NYSPA) appreciates and values the Mayor’s commitment to assist individuals with mental illness, we caution against the use of involuntary commitment as a blanket solution without examination of other root causes and solutions.  It is well-established that individuals with mental illness are much more likely to be the victim of a crime rather than the perpetrator of a crime and involuntary commitment may not be appropriate in all cases.  Other factors at play include rising rates of homelessness, lack of access to care, long-term healthcare disparities caused by under-investment in community-based resources, and the ripple and long-term of effects of the COVID-19 pandemic.

A recent audit of the New York City Department of Social Services by the NYS Comptroller’s Office found that the City is missing opportunities to refer individuals to specialized mental health homeless shelters and that during a four-year period, 26% of individuals who were diagnosed with a serious mental illness were not placed in an appropriate shelter setting. It is key that we utilize and properly fund existing and new community-based resources and consider alternative options before employing short-term solutions, such as forced hospitalization. Further, any psychiatric hospitalization must be accompanied by robust post-hospitalization supports and services, including greater use of mental health shelters and other temporary housing, opportunities for affordable, long-term housing and ongoing access to community-based mental health services. Otherwise, the revolving door in and out of hospitals will continue.  

Finally, we must recognize that any current mental health crisis resulting in homelessness for some of our most vulnerable populations is fueled in large part by a lack of affordable housing and a need for increased investments in supportive housing programs.  In addition, any solution to assist individuals with serious mental illness must include efforts to re-open the more than 1,000 inpatient psychiatric beds that were closed during the height of the COVID-19 pandemic as well as efforts to reach individuals in need before a crisis situation arises.  At this time, approximately 850 of these psychiatric beds are still devoted to general medical use, and at least one-half of these beds are located within NYC. Conversion of these beds back to psychiatric inpatient units will expand options for coordinated care leading to voluntary hospitalizations where needed. In fact,  New York has seen thousands of psychiatric beds come offline over the last decade or so, which would only be feasible with significant complementary investments in community-based care. One cannot occur without the other. 

The behavioral health workforce is also in need of additional investments and NYSPA is pleased to see that New York State recently allocated $9 million in loan forgiveness for psychiatrists and psychiatric nurse practitioners who agree to work in licensed community mental health programs for a period of three years. This comes amid the launch this past summer of 988, the Suicide & Crisis Lifeline, and the recent launch of crisis stabilization centers in New York State, both of which will enhance connections to care in the community.  

In conclusion, any efforts to re-locate individuals currently living on the street must be carefully considered and bolstered by equal investment in affordable housing opportunities and ongoing community-based services for individuals in need.  Many of the proposed elements of the Mayor’s plan will require legislative and executive approval and NYSPA looks forward to engaging in ongoing discussion on these critical issues.  

Edward Herman, M.D., J.D.
President, New York State Psychiatric Association