Nearly one year ago, Mayor Eric Adams directed city agencies, including the NYPD, to involuntarily remove and hospitalize those experiencing mental illness in public, expanding the interpretations of the existing Kendra’s Law which mandates treatment for those deemed “unlikely to survive safely in the community without supervision.”
Advocates widely criticized the move with concerns ranging from the lack of consent to New Yorkers, especially those who were nonwhite, getting mistakenly swept up.
Human Rights Watch (HRW) researchers are the latest to address those concerns, releasing a report this week advocating for a “rights-respecting” and community-centered approach towards mental health crisis support.
Olivia Ensign, senior advocate and researcher at HRW’s U.S. program, says the city’s directive impacts Black and brown New Yorkers the most due to housing, employment and healthcare discrimination.
She also references the U.N. Convention on the Rights of Persons with Disabilities, which specifically mandates “health professionals to provide care of the same quality to persons with disabilities as to others, including on the basis of free and informed consent.”
“Recovery means different things for different people, but one key element under human rights law is having control over one’s own mental health treatment and that can include the option to refuse treatment,” said Ensign. “Just because someone has unhoused or disability status, that doesn’t remove a person’s right to personal autonomy and legal capacity.”
Through the report, HRW determined that a human rights-respecting approach for mental health service providers requires prioritizing the choices of people experiencing mental health crises and going beyond the immediate intervention and de-escalation. The findings suggest services addressing immediate needs like food and housing, along with other factors like racism and discrimination, are critical.
The case study looks at Toronto’s Gerstein Crisis Centre as a model, which Ensign calls a “detailed, viable, [and] replicable framework for a holistic approach to mental health crises.” Established in 1989, the Canadian service provider reroutes those in crisis away from unnecessary police and hospital emergency interactions and into a consent-based response. Like in New York, Canada often employs police as first responders to mental health crises, found HRW.
“There’s a number of ways in which we are available to people, including a telephone crisis line [and] our mobile teams that go out and see people in the community. We also operate a couple of houses with short term crisis beds,” said Susan Davis, executive director of the Gerstein Centre. “We have also recently added some specific teams…where there’s been a lot of street activity and conflict with businesses and so we have a team that is available in two neighborhoods in Toronto.
“The goal behind that team is to give the community something other than the police to call [when] they’re worried or when they’re having difficulties with somebody, and providing a more appropriate response.”
The Gerstein Centre also boasts a significant number of staff members—including leadership—who live or have lived with a mental health condition, which HRW deemed critical to fostering community-based support. Ensign said the service provider offers just one of many ways that mental health crisis support can respect human rights.
“The hope is, for the many kinds of programs that are happening across the United States right now, as well as in New York, that folks look at this model and hopefully draw out some lessons and again, an example of good practices, and hopefully integrate it [into] all the work that’s going on in New York,” she said.
A spokesperson for the mayor responded by email, defending the directive and saying that Adams maintains “there is nothing humane about the decades-long practice of turning a blind eye toward those suffering from severe mental illness, especially those who pose a risk of harm to themselves.”
“We believe people with severe mental illness also have rights to food, clothing, shelter, and medical care—something many do not have access to now—and the right to not be perpetually tormented by terrifying delusions and hallucinations,” added the spokesperson. “To deny these rights is heartless and an abdication of our moral responsibilities. We will continue to do everything in our power to help those among us in a severe mental health crisis, even when they are unable to—by no fault of their own—recognize their own needs.”
Most publicly known data about involuntary removals come from public records requests obtained by organizations like the New York Civil Liberties Union (NYCLU).
From November 29, 2022, to February 28, 2023, 112 involuntary transports were made between behavioral health professional-led Mobile Crisis Teams (MCTs) and the interagency Subway Homelessness Outreach Teams. Only the MCT documents track the data; Black New Yorkers are the most involuntarily removed. Transport referrals for Black New Yorkers, both voluntary and involuntary, were also the highest.
NYC Health + Hospitals (H+H) told the NYCLU that 38 individuals were “identified for evaluation under the NYC Mental Health Involuntary Removals Policy” and 24 were connected with housing services. Race was not provided to protect patient privacy.
The City Hall spokesperson said the figures will be available within a few weeks.
Beth Haroules, NYCLU staff attorney and director of disability justice litigation, said currently there’s not enough data to extrapolate from.
“If we were to go with the numbers that I got back in the spring, in a way, it tracks anecdotally [with] what we’ve heard, which is not a lot of people have been impacted here, but there is no sort of real time data that’s being released,” said Haroules. “There’s no dashboards, there’s no accountability.”
And while the affected population seems nominal based on known information, Haroules is concerned that as the weather gets colder and sheltering in the subway system becomes more common, the potential for removals will increase.
“I am concerned because the policies still exist,” she said. “The directive is still there to the NYPD and also to the clinicians in the city, [in] hospital settings, to direct people to be picked up.”
Tandy Lau is a Report for America corps member who writes about public safety for the Amsterdam News. Your donation to match our RFA grant helps keep him writing stories like this one; please consider making a tax-deductible gift of any amount today by visiting https://bit.ly/amnews1.