The Adams administration continues committing to commitment. Mayor Eric Adams announced his Compassionate Interventions Act last Thursday, Aug. 14, at a Manhattan Institute event, delineating plans to push expanding involuntary commitment laws towards substance abuse during the next state legislative session.
“From ‘the Hub’ in the Bronx to Washington Square Park in Manhattan, illegal drug use and the quality-of-life issues that come with it are far too common, creating serious problems for residents, visitors, and small-business owners,” said Adams. “The evidence is right there in front of us: people openly using illegal drugs on the streets and in our parks, or passed out in doorways and sidewalks; encampments littered with syringes and vials; and unsanitary conditions that are a threat to public health and public order.
“This cannot be allowed to continue. We must help those struggling finally get treatment, whether they recognize the need for it or not. Addiction doesn’t just harm individual users; it tears apart lives, families, and entire communities, and we must change the system to keep all New Yorkers safer.”
Currently, state law allows forced hospitalizations for serious mental illness, but the practice remains controversial, given the circumstantial discretion employed to transport someone for an evaluation without their consent (a clinician ultimately will have to diagnose the individual with a mental illness to hold them for treatment). The law does not include substance abuse, which the Compassionate Interventions Act is intended to amend.
The Adams administration maintains the proposed involuntary commitments for substance use would be a rare authority reserved for the most at-risk individuals. Nurses or other clinicians would decide if an individual should be evaluated and a doctor would then have to diagnose a severe substance abuse. Hospitals would have to provide a high burden of proof in the event a commitment is challenged in court. Further details remain in the works as the legislation gets drafted.
As the state’s involuntary commitment law stands, someone brought in for serious mental illness cannot be mandated for treatment if their episode stems from a drug-induced psychosis. Medical providers can engage them with voluntary recovery services, which they can refuse.
Adams has long championed involuntary commitment and involuntary outpatient commitment, which allow the court to order recurring psychiatric treatment in New York State under Kendra’s Law. He successfully pushed for the state legislature this year to add language toward the involuntary commitment statute to allow transportation for people “unable or unwilling” to feed, dress, or provide other basic needs for themselves. The recent state budget also included $16.5 million for municipalities to bolster Kendra’s Law treatment and another $2 million to monitor the involuntary outpatient commitments.
To be clear, the next legislative session convenes next year. By that time, either Adams’s successor will have taken office, or he will have won a second term in the November election. This means the Compassionate Interventions Act would ostensibly serve as a re-election promise.
Critics fear Adams’s advocacy focuses mainly on removing “unsightly” individuals from the streets on behalf of frustrated residents and local business owners, rather than truly promoting recovery and overdose prevention. Proponents say involuntary commitment skips the red tape for people who cannot properly consent to care (and frequently refuse help) to receive treatment.
“Forcing people struggling with substance use into treatment will not deliver recovery to the person or real community safety,” said NYCLU Executive Director Donna Lieberman. “Forced treatment can greatly increase the risk of a fatal overdose, raises serious due process and civil liberties concerns, and contributes to harmful stereotypes about people with substance use disorders.”
Debates over involuntarily committing people who publicly use drugs often center in Black and Brown neighborhoods like Harlem, East Harlem, and the South Bronx, where the Hub has become a hotbed for enforcement under the Adams administration.
At least two major voices in Harlem back Adams’s plan. Council Member Yusef Salaam extolled the Compassionate Interventions Act as “a bold and humane step forward in addressing the substance use crisis affecting too many of our communities.” Barbara Askins, 125th Street BID president and CEO, also called for the new legislation. “We have had some individuals in our district that have been out on the street [for] two to five years and we have not been able to get results because of the current laws,” she said. “It is time to realize that we need a way to provide much-needed services.”
As the Adams administration courts state lawmakers to back the legislation, mental health committee chairs from both chambers told the Amsterdam News they oppose the mayor’s plan in a joint statement. State Senator Samra Brouk and Assemblymember Jo Anne Simon believe compassionate care stems from community-based measures upholding “dignity, human rights and the safety of all people,” pointing to the Daniel’s Law bill which would approach serious mental illness and addiction as public health issues rather than public safety threats.
“Mayor Adams’ ‘Compassionate Interventions Act,’ is not rooted in compassion; instead, it centers involuntary commitment and forced detentions as its guiding principles,” said Brouk and Simon over email. “This proposal treats people in crisis as a nuisance to be swept out of public view rather than human beings who deserve care and dignity. As Chairs of the Mental Health Committees in the New York State legislature, we know that mental health and healing are most effective when rooted in person-centered, evidence-based interventions such as supportive housing, Intensive and Sustained Engagement (INSET) teams, and culturally competent crisis response.”
Under Adams, overdose deaths are steadily declining, although federal cuts will pose new challenges because many New Yorkers will be kicked off subsidized health care used to cover addiction recovery medication like methadone and buprenorphine. In addition, a volatile drug supply means those returning to drug use will risk low tolerance and face greater risks of overdosing.
Evidence shows that criminalizing drug use kills. On the surface, involuntary commitment seems like an appealing alternative to a drug war — Adams maintains that “this authority would belong solely to the doctors and nurses responding to people in need.” The wrongfully convicted Salaam’s support stems from his belief in an approach “to treat addiction not with punishment, but with compassion, care, and a commitment to real recovery.”
However, civil commitment can look quite carceral in practice. Massachusetts, one of the 37 states where involuntary commitment laws include substance abuse, uses correctional facilities for commitments. Reporting from the Intercept and Type Investigations found people forced into addiction treatment often found themselves in jail-like conditions, which led to deterioration rather than recovery.
Brian Stettin, Adams’s senior advisor on severe mental illness and architect of the proposed legislation, told the Amsterdam News that the Compassionate Interventions Act would avoid holding people for prolonged periods, which led to the jail-like (or actual jail) conditions in states like Massachusetts. He believes the city’s vision for holding people in short spurts would be wholly different from existing practices.
“What we’re talking about here is really just a time out,” said Stettin. “We’re talking about introducing the possibility of a really short-term hold in a hospital to get somebody through the physical withdrawal that often prevents them from recognizing their own need for substance abuse treatment.”
Before someone would be discharged, the city would connect the individual to harm reduction and recovery programs (the Adams administration announced $27 million in funding for such services). There are no plans for involuntary outpatient commitments akin to Kendra’s Law for substance abuse in the Compassionate Interventions Act.
Stettin also believes New York City’s integrated hospital system through Health + Hospitals will allow the Compassionate Interventions Act to function more effectively than existing involuntary commitment laws for substance abuse, which typically rely on private hospitals that do not see forced treatments as profitable.
Ann-Marie Foster, president and CEO of Phoenix House, a service provider operating city-funded mental health clubhouses, including a new location in Central Harlem, told the Amsterdam News she is disappointed with a reversion to “failed policies.”
“You don’t want treatment to be seen as punitive, as either you do this [and] go to treatment or this will happen [like] criminalization,” said Foster in a phone interview. “That’s been tried many times, and that has also failed. You want to make treatment attractive. You want to make treatment such that people say, ‘You know what, I’m sick and tired of being sick and tired, and this is a viable option for me.’”
She has seen it, Foster added. “I’ve worked in those systems before. People come in, they’re intoxicated, they’re put on a gurney, they’re given a sandwich, and they go right back out the door. I haven’t heard anything that’s going to say it’s going to be different this time.”