Involuntary removals steady over last year under Adams policy

Last month, not for the first time, New York City Mayor Eric Adams was asked about how his administration can proactively address random acts of violence. The question has come up in relation to crime in the subway system, but as recently posed to Adams, it concerned instances of women being randomly punched by men on the street.

And not for the first time, Adams pointed to the city’s efforts to involuntarily remove people experiencing mental health issues, transporting them to a hospital where they are evaluated for admission. “This is why we have been fighting for involuntary removals,” Adams said at the Aug. 20 press conference, noting that the city has found that many people involved in random attacks are dealing with severe mental health issues. “People who are unable to take care of themselves, harmful to others – and one proactive way is to get them inside care.”

In November 2022, the Adams administration rolled out a new directive to make it easier for the NYPD and other outreach teams to involuntarily remove people experiencing mental health crises and bring them to hospitals. And despite the swift backlash from mental health advocates and some lawmakers who argued that the city should be focusing on long-term care and housing rather than involuntary hospitalization, the administration continues to describe the policy, nearly two years in, as a success, helping those who might have previously been overlooked receive care.

In November, one year after the directive was announced, the city reported averaging 137 involuntary removals per week since May. It’s unclear whether this represented an increase or decrease over previous years, as the city didn’t previously track that data. Among the 100 members of lists of some of the hardest to reach individuals known to the city for needing help and being resistant to care, the city reported moving 54 people off the street and into housing or hospitals, a 145% increase over the previous year.

The city is holding off on another full update on outcomes for those on its Top 50 lists until this November. But between January and July of this year, the city was again averaging nearly 130 involuntary removals per week, according to City Hall. That includes removals made by the Metropolitan Transportation Authority and city’s joint Subway Co-Response Outreach Teams, in which MTA police and clinicians work together. Since last fall, the teams working the day shift got 99 people to accept shelter, 26 people to voluntarily go to the hospital for assessment and made 24 involuntary removals, while the night teams made 27 involuntary removals.

Since Adams announced the new directive on involuntary removals, mental health advocates have warned that the policy will result in rounding up New Yorkers who aren’t actually in need of hospitalization or who need other kinds of care besides hospitalization. Some mental health advocates see the directive as political, driven by an interest in assuaging fears about crime. As the mayor faces a competitive reelection bid next year, the administration’s approach to addressing severe mental illness may become a major subject in the race. City Comptroller Brad Lander, who is running against Adams in the Democratic primary, has named ending street homelessness of severely mentally ill people as a top priority. Lander opposes the administration’s efforts to lower the standard for involuntary removals through state legislation, which a top City Hall mental health adviser said they are still hoping to advance.

Meeting basic needs

Nearly a year into his tenure at City Hall, Adams, flanked by the city’s top health officials and a couple state lawmakers, announced a new plan for reaching and treating people experiencing severe mental illness. The administration announced it as a clarification of the existing state Mental Hygiene Law, seeking to dispel “a myth” that involuntary removals were only meant to be used when there’s an overt act of violence or imminent threat showing that a person is a danger to themselves or others. Instead, the city said in a directive with concrete steps for NYPD, EMS and Department of Health and Mental Hygiene outreach teams, the law authorizes the “removal of a person who appears to be mentally ill and displays an inability to meet basic living needs, even when no recent dangerous act has been observed.” The city also announced additional training for outreach workers, first responders and clinicians – the latter of which ultimately make the decision on hospitalization once the NYPD or mobile crisis outreach team determines transportation to a hospital is necessary.

“The authority was always there. It’s been just about educating our first responders and crisis outreach folks that they actually do have authority to respond in situations they might have previously thought they didn’t,” Adams’ senior adviser on severe mental illness Brian Stettin told City & State recently. “And that has led to us bringing people to the hospital who previously would have been left alone, left to rot.”

Though the new directive was characterized by city officials as more of an information campaign than a policy change, the city also sought to make the interpretation explicit in state law, with the basic needs standard specifically included.

Assembly Member Ed Braunstein sponsors legislation that would do that, though it stalled in committee this year. Stettin said the city hopes that changes in the upcoming state legislative session.

Some advocates, including some who sought to block implementation of the directive in a lawsuit, remain concerned about the policy. Ruth Lowenkron, director of the Disability Justice Program at New York Lawyers for the Public Interest, said she remains concerned by the examples that have been mentioned by city officials as behavior that could lead outreach workers to determine a removal is necessary, such as a person shadow boxing (mentioned by the mayor) or an individual smelling of urine (mentioned by an NYPD official). “Is that someone who can’t take care of themselves? Probably. But is that someone who is a danger to themselves, let alone others? Highly unlikely,” Lowenkron said of the latter example, which was mentioned by an NYPD chief at a City Council hearing, but also in an NYPD presentation.

Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, credited the city and the state with investing in models of care that better address the needs of people with severe mental illness. That includes the state’s investment in several voluntary, peer-led engagement teams, and the city’s investment in mental health clubhouses – though some existing, smaller clubhouses don’t meet new standards for funding.

While Rosenthal said those efforts have been positive, he argued that the continued interest in “coercive” tactics like involuntary removals stem from narratives about crime that pigeonhole people with mental illnesses as a threat. “We have a lot of voluntary ways to engage folks, but the politics of the situation have changed everything, and the politics are that the public is frightened for their safety,” he said.

Seeking data

Advocates have attempted to extract more data on how the directive has been implemented; the New York Civil Liberties Union sued the NYPD for records last year. For now, there is only a limited amount of information reported by the city. Stettin said the city is looking not just at the removals, but how people do over time and where they go next, particularly for those on the Top 50 lists. How much additional information on outcomes will be included in the city’s two-year update expected in November is unclear. Anecdotally, Stettin said that most of the nearly 130 average weekly removals aren’t among people in the subway system or on streets, but people in more stable living situations.

Soon, more information will be available about who is affected by the removals. Legislation sponsored by New York City Council Member Linda Lee passed last year that will require the city to report more detailed information – including geographic and demographic data – as of this coming January, though it doesn’t require reporting on outcomes of the removals, or where individuals go after hospital stays. Stettin said the city is preparing to meet that deadline and will publish the data on a dashboard. He suggested, however, that collecting demographic information can be a challenge if police or EMS are guessing about a person’s race or background. “There may be some limitations on how collectible some of that information is, but we’re going to do our best to comply with the law,” he said.

Among those who may be looking out for data on how the city is implementing the removals directive are challengers to the mayor who have criticized his approach to mental health care. Former New York City Comptroller Scott Stringer, who is running against Adams in the Democratic primary next year, called the administration’s response to mental illness an “abject failure.”

Criticisms that the city should be focusing less on involuntary removals and more on the continuum of care and supportive housing is a “classic false choice,” Stettin said, saying the city isn’t just focusing on the former. In November, the city celebrated a 130% increase in moving people staying in shelters with wrap-around services into permanent housing. 

Lander, who as the city’s current comptroller has audited the city’s sweeps of homeless encampments and a health department mobile treatment initiative, said there hasn’t been enough data on what happens after hospitalizations. “If we’re actually going to solve this crisis, people need to be connected to stable, permanent housing with the services they need to stay in it,” Lander said. “The most important thing remains the thing that is the most missing, the biggest hole.”