It’s Time to Make Changes That Matter.

The NY Times has finally come to the conclusion that leaving mentally ill people on the streets to fend for themselves in not humane and not a legitimate public policy.  And that is what has been happening for years now. 

In a series of articles over the past week, the “Newspaper of Record” has called for reform in the public mental health establishment.  There is some good reporting in their coverage on a number of concerning failures. One wonders what has taken them so long.

Times writers Amy Julia Harris and Jan Ransom claim that, “Violent attacks by homeless, mentally ill people are relatively rare….. But each act of violence — every subway shoving, stabbing or slashing — can shake the city’s psyche.”  The first claim is incorrect, the second is obvious.  Mentally ill people are, at times, violent, often with horrific and deadly results.

An analysis by the NYPD in 2022 showed that 22% of all felony assault arrestees had a documented mental health history and were classified as an Emotionally Disturbed Person (or “EDP” in NYPD parlance).  One can only imagine how much that number would spike if you included those arrestees who were ill but not documented.    

So, what is being done by the massive public mental health system in New York City?  Not much, it appears.  The system is the definition of a revolving door.  People desperately in need of services are being released back on to the street with deadly results. 

I recall one shooting in 2021 where police officers were called to an apartment in Maspeth to handle an EDP.  They knew the address, they had just been there earlier in the day to help remove a mentally ill man to the hospital.  In the apartment there was the very same mentally ill person they had earlier removed.  This time he had a knife.  Police were forced to shoot the man, causing a serious injury. 

Why couldn’t they handle the incident without resorting to shooting?  They already did!  Earlier in the day! And some half dozen times before that.  But this hallucinating and visibly ill man was released right back into the street for the next tour of cops to handle again.  At some point there will be violence. A sick man trapped in his own head and not getting help will get frustrated and lash out.  At some point, words fail.  De-escalation techniques can only accomplish so much. 

The New York Times has never seen things that way.  Always quick to blame cops and call for mental health professionals, they now see the dysfunction in the system that cops have known all along.  Of course, the primary culprit for the Times is a lack of funding.  That is despite the de Blasio family spending a billion dollars on its ThriveNYC scam.  “Throw more unaccountable taxpayer money at the problem” is a great tradition in New York City governance.  So is the failure of that approach.

Some failures in the mental health system found by the New York Times are:

• Despite spending over $1 billion on dedicated mental health shelters, the mentally ill often don’t get placed in them.
• The City’s public hospitals have regularly discharged people in severe psychiatric distress, often in violation of federal law.
• Discharges prior to proper treatment seemed to be linked to a patient’s insurance status. Medicaid patients are less profitable (a lesson for those who want the government to take over insurance) and get discharged more quickly. 
• It is only when an individual commits a serious offense and is imprisoned that they receive some consistent treatment.
• Public health agencies often do not or cannot use the State’s mental health treatment database called PSYCKES, due to HIPAA violation concerns, incompetence, or laziness. This database could be critical in properly diagnosing and placing the mentally ill. 
• Times reporters have identified 94 instances where a mentally ill person committed a violent act just hours or days after being released from care. The real number is certainly exponentially greater.

So What Could Work?

It seems that one major issue is incompetence and inefficiency at the governmental level. One particularly galling quote came from NY State Office of Mental Health Commissioner Ann Marie Sullivan who stated, “I think we’re on a path here to provide some really good community-based care.”  Glad to see she thinks we are on a good path.  This is not a new problem, how about showing some results?

As much as we know that government agencies need reform and accountability, there is more that has to be done.  And that involves legislative change.  Here are a few examples where laws can improve the mental health landscape:

• HIPAA laws often prevent information sharing amongst health care workers. HIPAA waivers that allow information sharing are often ignored, and minor, well-intentioned, violations of the law are taken more seriously than is reasonable.  This law must be changed to ensure that mentally ill patients can get the care they deserve across multiple care providers.
• It is not easy to admit an involuntary patient to a mental health center without their consent. In New York State families or specific government employees must apply for inpatient treatment and two psychiatrists must certify the application.  Good luck getting that done at 3 am on a Saturday!  Emergency admissions are possible but require a certification within 48 hours.  There needs to be more common-sense laws that allow for admissions based on behavior and diagnosis.  Get first responders more involved if necessary.
• Release requirements must be strengthened. In New York, if a facility wants to keep a certified patient for more than 60 days, it requires a court order signed by a judge. Appeals and legal processes impede this process.  Emergency admissions must be released within 15 days and the same court process applies.  If a person still presents a danger, they should not be released because of an administrative failure.
• There must be some legal accountability for failures in health care and unwarranted releases of dangerous people. We cannot have heath care institutions continue to allow sick and dangerous people to walk out of their facilities with no consequences. 
• For all the talk of criminal justice reform, the mental health aspect to crime has not been significantly addressed. Mental illness plays a huge role in crime, not always in the obvious way that we see when a deranged man pushes a stranger in front of a subway car.  It is an underlying cause of much, if not most, crime.  You can find studies that show the link is minor, but I can attest from firsthand experience that many of the people arrested are suffering from some sort of mental disorder.  They cannot function in mainstream society.  So: In-patient diversion programs need to be increased, post-supervision release should include mandated mental health care or medication, and prison systems should be required to increase their diagnosis and treatment for less obviously ill inmates. 
• And finally, the media could play a stronger role by naming and shaming the judges who are so willing to simply turn mentally ill perps around and push them back out the door.

If federal and state legislators were able to codify some of these improvements, it would go a long way to getting a handle on our country’s mental health crisis.  It is time to stop pumping money into a system that is not working  – the bureaucracy in New York resembles an employment service more than a functioning system.  We must try new techniques, new programs, and new laws to find effective, proven solutions. 

And all that will also take that rarest of qualities these days (especially in our cities): political courage.

When an outlet as liberal as The Times sees the light, you know the public must as well.  Public support for these changes would be overwhelming.  It is time for our politicians to recognize that any progress in this area is a winner – for them, for the mentally ill, and for the people these politicians ostensibly serve. 

Will anyone in office take up the challenge? 

Thanks for reading The Ops Desk.  Stay Safe!