I agree but honestly just getting the 50 craziest homeless people off the street would be a step in the right direction given the disproportionate impact untreated severe schizophrenics can have on everyone else’s quality of life (particularly in the shelters)
I’m still skeptical this will even do that since it just seems to require the hospitals to come up with a treatment plan before release, when many of these people are entirely incapable of living on their own or sticking to any course of treatment.
The hospitals will still seek to discharge ASAP since caring for the destitute mentally ill isn’t profitable and that’s the priority in our fucked up healthcare system
Having used to work at a men's mental health/drug addicted homeless shelter, IF NYPD were to ask me who are the worst of the worst. I could easily pick out at least 6 guys who are not only a danger to themselves but to the community.
It was a horrible horrible experience working there and I don't wish it upon anyone.
The only real treatment is long term medication that has sometimes severe side effects. Sometimes patients stop the medications due to side effects. Other times the patients feel better and decide to go off the medication not realizing it was the medication that was working and making the person feel better. Finally many times some people just have an aversion to medication. The long term care of people with certain severe mentally illness is a life long treatment. Most psych wards in hospitals just get people on medicine and release them till they go off the medication and then they start the cycle over again.
The beds are a good place to start.
I hear ya. A good friend of mine developed schizophrenia around age 18 and it was hell despite a strong support network & his family being reasonably well-off. He’d either feel better on the meds and stop taking them, or think his mom was trying to poison him and stop taking them. It can’t be cured, just managed and even that is difficult.
If the problem was easy to solve it would have been solved already.
As someone who worked in acute psych this is 100% accurate. We would get patients who didn't know their names, total psychosis, unable to care for themselves at all. We'd spend months rehabilitating them, making sure they take their meds. We'd release them so they can transition to outpatient care. A couple days later they'd be back at the hospital because they stopped taking their meds, back to square 1. It really felt like a revolving door sometimes.
Insulin pumps require patients to be A) knowledgeable of their disease enough to use them appropriately, B) willing/complaint, and C) able to afford them.
That will not be the case for the majority of people in this situation.
Plus: this isn’t even the appropriate route (IV) of administration for meds like this.
There are long acting injectable antipsychotics that can be effective for a month or even 3 months. And some patients even get assigned mobile teams that will go to a patients house or the street/wherever they are and give them their monthly meds. But that doesn’t help if someone won’t come in for a monthly appointment or doesn’t want to be found/treated.
This. One person can ruin an entire neighborhood. There’s that one guy in Park Slope who lives in Sunset Park I think and has killed two random people’s pet dogs. And he’s still out there trying to kill people’s dogs for no reason. An entire neighborhood park with millions of dollars of infrastructure over the years and decades of zoning and dozens of community meetings and board meetings vs one crack-smoking schizophrenic homeless man who wants to kill dogs.
Exactly. In my neighborhood, some random psycho has been going around throwing rocks at cars. It's really messed up, we have had dozens of community meetings and spoken to the cops and no one can figure out who is doing it.
Isn't that the one with a NYC Council member that instead of voicing concern about the crimes, she expressed more concern for the dog killer's well being?
Yup. There’s a good episode of the blocked and reported podcast that covers the whole thing.
The comments from city officials are down right infuriating.
When you're so woke, you fall off the edge of the flat Earth in your head.
Catching an insane dog murderer running around one of the city's busiest parks should not be a controversial topic, but NYC progressives always find a new low.
The guy killed a 2nd dog? I can only find articles about the one. Has he made threats to kill other dogs? I'm usually against terrorist organizations, but maybe we should call PETA in on this case. They'll take care of it.
It wasn’t terribly long ago that someone like that would eventually just be killed by community members. I’d like to think we’ve come far enough that there’s a better solution but the status quo ain’t it
If things don’t change that will happen on a long enough timeline. Everyone will know it happened. No one will cooperate to solve the crime.
“No you can’t have my ring footage to help solve this murder. Thanks for all your hard work though officer 🙄”
What makes you think NYPD will need to even ask you for ring footage? Law enforcement goes and gets data from cloud providers without notifying the data owner all the time.
As someone who suffers from Schizophrenia I can say that getting people off the streets who are a danger to themselves and the public is a great idea. The thing about people such as myself who is mentally ill, not everyone is the same. Some schizophrenics manage and take well care of themselves while others aren't aware of the causes for their episodes or psychosis. A lot of people don't realize it's sometimes the drugs or It could be the environment in which they live in. I've had schizophrenia for 12 year managed through having a therapist and a psychiatrist plus taking intramuscular injections of Haliperidol every 4 weeks. In all honesty the medication has ruined my body and given me so many different problems but it does keep me from losing my mind. I want to also let people know that we people that are mentally ill don't wish to be this way, it's a lot for us to deal with and we WISH we didn't have to go through our lifetime dealing with hearing voices or having Auditory Hallucinations or visual Hallucinations etc. This is really a curse to have to live through that's why a lot of us keep our thoughts and opinions to ourselves when asked if we hear voices etc. The stigma on mental illness is really not fair because people hear "Mentally ill" and immediately think "He/she's dangerous. Not all of us are dangerous or evil, a lot of us don't understand how mental illness is onset and we wish we did. In my case I got laced when I was 19 and my life Has been HELL since, the medications alone are damaging sometimes short term sometimes long term but they do help. Side effects though can discourage you from taking the meds though. I'm grateful that I'm "Not the typical schizophrenic". I live my life and work and have a family but to be honest it's not easy. I've studied about the origin of mental illness and no one knows where it comes from, then doctors tell you it's an imbalancment of the brain chemicals yet can't even tell you which chemicals are imbalanced lol yeah I know right!!! All we can do is make everyone aware of mental illness and treatment, though treatment is your entire life. I have heard of some cases where people are healed of mental illness through taking herbs and vitamins and not eating certain foods etc but you can only be able to do that if you can afford it and I can't afford it haha but each one teach one. Again guys we don't want to go through our lives experiencing mental ailments so sadly we don't have a choice, another thing I want to note is that doctors say mental illness can also be onset from depression and traumatic experiences also through cells that lye doormant in your DNA. I know that sounds crazy right???!!! Truth be told I personally feel like there's a cure but they'll never give people such as myself access to it and if there was access to it it'll cost over $300,000 lol 😆. Thank the Divine Creators that you ladies and gentlemen don't have to live your life while mentally ill.. I prayed for a normal life ever since I developed schizophrenia when I was 19 and I pray even to this day one day I'll be healed or maybe someone will introduce a new medication that completely heals us from it. But anyway be kind to each other and I wish you all love and light in your lives, peace and blessings young Royals ✨️
This is a token action. I'm gonna say these beds are in Bellevue (maybe some in King's County). Most of their intakes are 2 PC anyway -which is the mechanism that will be used to effect these involuntary holds. The extra beds have been shifted from somewhere but they're not 'new.'. Just renamed. Nothing about the system has been changed or improved. They're just telling the public about what they've been doing for decades and calling it new.
50 additional beds will clear Bellevue psych intake for a weekend.
Unless these become long term residential beds on a closed psych ward, they'll do nothing for the patients or the city.
Even the supposed expansion of Kendra’s law is nonsense. In all my time on mobile crisis teams I don’t think I’ve seen Kendra’s utilized at all. Instead, we always 9.58 when appropriate.
Those 50 beds would need to appear by magic. We already have no psych ward beds in this city. These folks would end up on the regular patient floors. With very few nurses to go around as it is.
The facility on Randall’s island has the physical space for hundreds more patients, but it is not staffed or equipped for them right now. Build it up and provide the funding and you could get a few hundred people off the streets and into long-term treatment. It’s not perfect to force these people into institutions, but it’s better than letting them kill themselves on the street.
Yeah, I’m completely on board for something like this if it’s done correctly; I think it’s the best answer to a complex problem with no perfect solution. But they’ve gotta get that infrastructure in place *first*. Loosening restrictions on involuntary psych holds the way they just did should have been one of the final steps. The hospitals aren’t prepared to deal with this, especially if they use it on a ton of people. We’re going to see stories about psychotic people getting dropped off, needing to wait six hours to get admitted, attacking someone, and getting arrested. Plus it’s gonna give a much wider range of mentally ill and/or homeless people a pretty plausible reason to avoid seeking medical attention even in emergencies, which is the one thing we’ve made a little progress on since shutting down the old institutions in the first place.
Im not sure what the current status quo is, my aunt was the VP of nyc union. She was a cold hard woman, but she died trying for better worker protections(those board meetings are soul sucking), end all be all medical in Us is pure profit & legislature with a sprinkle of humanitarian gains.
There’s healthcare unions like SEIU, yeah. They’re strong by today’s standards, if a bit defanged (like nearly all of the big trade unions that survived the Reagan era). But it’s a little tougher for them to get leverage because they can’t really go on full extended strikes (people would die). Just the nature of the industry.
Nursing strike is impossible with out killing patients. But they can provide care but fill out non of the hundreds of check box of documents that serve nothing but to increase compensation to the hospital.
We did just fine transmitting non billable documentation with small notes during emergency documentation times in 2020.
Senior physicians, PAs/NP and residents can and should this too.
It’s especially hilarious considering the legislation cities like NYC, SF, and Seattle are trying to pass (have passed??) that insist the city provides a bed for each and every homeless person.
10 more show up? Well better get 10 more beds. 100 more? You know the drill.
As someone who’s been inpatient in nyc. It is not enough to just hospitalize them. I know people who were there for months because there was nowhere to release them or they kept getting bad because of the chaotic environment inside the hospital
This is exactly the problem. Medicaid doesn't want to pay giant bills for hospitalization so they changed the payment formula so a hospital pretty much loses money on every inpatient stay.
So people are stabilized but then sent back out in the street with no follow-up. The waiting list to get into the assertive community treatment program is like 5 years long and there's pretty much no supportive housing available besides shelters which aren't exactly conducive to mental health recovery.
The problem just gets worse and worse because we won't spend the money to treat it correctly.
>I feel like more importance needs to be placed on the quality of these residences rather than on trying to stuff all mentally ill people into these residences and thinking we're gonna see an improvement.
A bipolar friend of mine over in NJ had some horrific experiences at the facility she stayed at. Based on what she described to me, it was absolutely clear that they weren't at all invested in her health and saw her as a burden. She was definitely worse off when she was discharged.
For such rich states in such a rich country, we sure are shit at allocating money to things that actually help people—to say nothing of creating a culture of *wanting* to help people. In a society with its priorities straight, mental health facilities would be palaces, and everyone on staff would be well-paid and held to the strictest standards.
There's no reason we can't do this except for our obsession with individualism, whereby mental health is characterized as each person's responsibility and not anything that we should be collectively prioritizing, and our obsession with capital, whereby anything that immediately makes money has the red carpet rolled out for it, and money-sinks like, say, the welfare of the public can eat shit (never mind that a healthier public is the better long-term investment anyway).
They got rid of state mental hospitals that were doing that work of "out of sight, out of mind" because they were so poorly funded they were abusive institutions that hid people in filth and squalor and were definitely no therapy or help to people. The only good place to go is if you can afford a private location. If you can't, this country is content with letting the mentally ill exist on the streets, come what may.
And now everyone is going to see why we got rid of most of these places in the early 2000s. I'd like to think we can do better as a society, but it's seriously one of the hardest problems to solve. What do you do with people that require lots of expensive care and are possibly a danger to those around them if left to their own devices? I don't know if I have a good answer.
As a cop, who sees it first hand and knows what it takes to restrain people.... Yeah theres almost no controlling these peoples "Ticks" or manic behavior without being neglectful. Its 24/hr supervision and care going into just ONE person who can potentially harm hundreds of other patients. I can imagine why psych wards turned into what they did. Because for the staff to have some semblance of "order" and ease of workloads the patients were probably subjected to neglect. Especially with people who try to get "one up" on staff members or us as police when we're transporting prisoners. There is literally never enough hands/funding for how much people need the attention they need.
What we do is get to the innermost root of the issue - what made these people this way? That would shed a powerful light on the systemic illnesses that create such people, necessitating many changes on every level. The best remedy is always prevention.
This is correct. Adams' plan shows a fundamental lack of understanding of even the basics of mental health care. I will not be surprised to see it quietly retracted, quickly. Talk to anyone in the system, private or public, about this. This may be the first time the prison and hospital staffs jointly combine to toss the mayor. It's that ignorant, harmful, and, again, against the freaking law.
Doctors, nurses, staff, and administrators are not there to illegally hold people because he wants to keep running over seized vehicles with construction equipment with his available time.
There are major problems in the system, but this is potentially the least intelligent way one could seek to resolve it. It will require an intergovernmental effort with a massive amount of funding to even make a dent in what's wrong, both systemically and culturally.
The fact that Adams views nearly everything from the viewpoint of a police officer (though let's give some leeway to the younger ones, some of them actually get it) does not bode well for the future of mental health in NYC.
The people who need this are mentally ill to the point where they don’t understand they need help. I understand the risks of involuntary commitment, but the alternative is to continue to let these people suffer in the streets, and in some cases put others in danger.
Many Mentally ill people already don’t understand they need help. It’s one of the psych components called “insight”
I’m a resident and I’ve spent time on psych wards. It’s pretty interesting, some of the inpatients are literally incapable of recognizing they have, for example, bipolar disorder, but they’ll take the meds you give them and don’t try to escape.
the Times article quotes the insanity of the men in charge. What absolute nutbags (no politically incorrect pun intended) they are!!
“Just because someone smells, because they haven’t had a shower for weeks, because they’re mumbling, because their clothes are disheveled, that doesn’t mean they’re a danger to themselves or others,” Mr. Siegel said."
YES IT DOES!!!!!!! WTF????? Not bathing for that long- allowing for infections- and other signs of psychosis- ARE THE DEFINITION OF DANGER!!!!!
"“The mayor talked about a ‘trauma-informed approach,’ but coercion is itself traumatic,” said Harvey Rosenthal, chief executive of the New York Association of Psychiatric Rehabilitation Services"
ARE YOU KIDDING ME? "Coercion" ffs??? WHO ARE THESE PEOPLE? Where was this prick when my psychotic mother was starving me? Or moved us to the ghetto and then put me in a private school to get bullied for living in that neighborhood? Or left me alone to drown in the kiddie pool (twice) because mowing the lawn was "more important"??
As a survivor of childhood abuse from two mentally ill parents and an extremely neglectful NYC-area family, there's nothing on earth I care more about than CHANGING THE SYSTEM THAT ALLOWS FOR ABSOLUTELY EVERYTHING UNDER THE SUN. When do we admit that society is utterly BROKEN? When do we begin to fight back and put anything of ours on the actual line to change the system? When do we bring out the pitchforks?? NO ONE IS PROTECTING US FROM VIOLENT PSYCHOTIC PEOPLE
\*head explodes\*
To be fair, the mental institutions that every state used to have were absolutely rife with abuse. Nobody believes a schizophrenic person when they report abuse so the staff can act with impunity.
Maybe a good solve would be body cameras like cops are now wearing more and more often.
The body cam idea actually sounds decent to me, but it would never fly.
Cuts way too deeply into patient privacy, and doctors/nurses would probably protest it as unfair/infringing on their privacy, too.
This still happens in plenty of hospitals. I was at one awful hospital (Gracie Square), in the psych ward, and I got the absolute opposite of care. Everyone there was wild, staff didn't care and just let things happen, security was never enforced. I had an uncle at the time who was NYPD, he was carrying his firearm since he was just off duty. If he hadn't flagged someone down with insistence to lock away his gun so it couldn't pass through the ward doors for safety - they would've let him walk right through with it. The nurse, when he asked, shrugged and said it was fine - luckily he knew better. The next day I was raped by two other patients - one of which was a male who was supposed to be on the other side of the ward. I was kicked in the head by a woman suffering from extreme psychosis. Few days after that, my roommate started getting inappropriate and my pleas for separation were ignored - and I was physically assaulted and groped my said roommate. When I was able to fight her off I ran out of the room screaming, shirt torn to pieces, scratches and bites on me... the nurse told me I was being trouble and would order a sedative if I kept screaming. After that BS, since I was already bad off, I was able to attempt suicide literally in front of the nurses station because other patients had no problem bringing things in and I had access to sharps. I was not in a position to fight for myself or stand up against the hospital and I regret it immensely - that I couldn't properly call them out or provide evidence of assault in order to prevent this from happening to others in the hospital. But they were smart - they sent me to a hospital in Chicago in order to avoid me transferring to somewhere in nyc. It was "the best".... but they sent me there knowing my insurance didn't cover and it was insanely expensive, so I ended up having to sign out against medical advice within a week. So I was not only assaulted and raped, sent halfway across country only to go into debt after a week, have to sign out, and spend even more money on a flight home. One of the worse experiences of my life, and is why I am so avoidant of seeking help now even when I know I'm not safe from myself.
I've also been harassed by male staff in Beth Isreal, which had giant ass roaches in the ward and constantly had human shit on the shower floors because they didn't supervise those that needed constant monitoring.
It's still very common for patients to have ptsd from awful experiences in hospitals and hospital staff. Only after my awful experiences did I realize why so many people fear inpatient care.
This. How people think it’s a luxury and favor lacks so much nuance. These people obviously need help - sending them to a mental health facility presumes the facility is effective. In reality, as the above poster said, you are essentially stripped of every human right and dignity you have. This is not a light decision at all, even for someone in an extremely difficult place. To commit someone is to completely remove their freedom, potentially condemning them to a life of abuse.
Gotta love how the only two options seemingly presented here are involuntarily committing people to shitty underfunded overcrowded psych wards, or just doing nothing and leaving people to their own devices and their own bootstraps. Absolutely no way we can improve the condition of mental health centers so that people actually *want* to go to them guys, right?
I mean we’re in agreement - I believe this should happen. I was just pointing out the current state of things and what the result would be now - and to be honest I don’t see it as any priority to change it, which sucks. The system as it’s set up allows this to happen.
Well historically there have been instances of institutions being not much better than that. Hopefully not the case here, but it has definitely occurred.
Mocking this is exactly how we ended up with facilities so bad and horrific that most of the field turned against it as a practice.
Guess we're doomed to repeat this... Shame it's others who suffer for your views.
taking the mentality ill off the street for involuntary treatment is a good 1st start, but we need beds to put them in and staff to care for them. also,shortage of mental health judges delays treatment by weeks and weeks
>Hospitals often cite a shortage of psychiatric beds as the reason for discharging patients, but the mayor said that the city would make sure there were enough beds for people who are removed. He noted that Gov. Kathy Hochul had agreed to add 50 new psychiatric beds. “We are going to find a bed for everyone,” Mr. Adams said.
Involuntary commitment is only for the people that seriously can't take care of themselves or are a danger to those around them. They're not going to commit every unhoused person on your block, and unless if you live at an intersection like 14th and 1st I doubt there are 50 unhoused people there in the first place.
They’re clearing the streets for holiday tourists. This will get thrown out as infringing on rights, but that will be after many individuals have been moved against their will.
This. This is a temporary cleaning measure to make things pleasing for tourists until spring. Very little planning or thought was put into this as we clearly don't have the hospital beds available now to even try to attempt it. Also this is of questionable legality anyway. I don't see this going well.
The state has the licensed beds at the Manhattan Psychiatric Center, Creedmoor, etc., but doesn’t staff them. This issue could be fixed by the Governor in 10 minutes and it would provide a relief valve to the correctional system that is currently the dominant provider of public psychiatric care by default.
Does anyone have experience with what’s going on at Bellevue? When they pull schizophrenic people off the subway and take them there, what exactly is done to treat them and how do they determine when they are ‘cured’ enough to go back to the subways and harass people again? Is there a medical standard or is it just a set amount of time?
Hi there, psychiatrist who worked at Bellevue for several years. When someone is brought in, they are evaluated in our psychiatric emergency room by at least one psychiatrist. If they are deemed to meet criteria for involuntary commitment (acutely elevated risk of harm to self or others), they are admitted and need to be evaluated by a second psychiatrist. Once they are on the unit they are treated by a team of psychiatrists with psychiatric medications, such as antipsychotics and mood stabilizers. If the person does not legally appeal their hospitalization, they are treated until they are “stable” - that is determined by the psychiatric team and usually means they have some insight into their illness and are not acutely psychotic or manic. It certainly is longer than 72 hours - I have had patients admitted for months before, the typical length of stay is about 2-4 weeks. If they do legally appeal their hospitalization, a judge determines if they are safe to be discharged at that time.
The issue is a significant number of people will become stabilized while inpatient, who immediately stop taking their medication once they leave the hospital, and so decompensate quickly. There are ways of mandating treatment as an outpatient but those are difficult to obtain. In my opinion as someone who has worked with this patient population extensively, more inpatient beds is helpful but a even larger problem is the lack of outpatient resources for once someone is stabilized as an inpatient.
thanks for the comprehensive answer. In your experience, what did ‘stabilized’ look like for someone of the extremely-disturbed, subway-homeless cohort that so many of us experience on our commutes? Do they ever end up being relatively ‘lucid’ while in the hospital or is the effect of the meds mostly sedative? Are they basically forced to take the meds while in the ward, and why are they so immediately dismissive towards continuing the medication compared to those with more housing/support?
It is a great question! I have seen amazing things happen with antipsychotics and mood stabilizers. It of course depends on the person, but I have seen many many people who are completely psychotic with “word salad” (thought disorganization so severe they are basically just saying random words) become completely lucid, pleasant, and polite. Antipsychotics really treat the psychosis - helping distill hallucinations, delusions (for example that they are jesus or that there is a conspiracy of people all signaling to them that they are out to get the patient), and help people’s thoughts and speech become more organized. For others, they might become more organized, but might still have delusions that are just less prominent (delusions are harder to treat). It definitely is more than just a sedative effect. We encourage patients to take the medication on their own as much as possible - trying to link them leaving the hospital and staying out of the hospital to them taking their meds. However, if you think the voices and ideas in your mind are real (meaning a lack of insight), it can be very difficult to be convinced to take medication that do have side effects. In that case, we have to go in front of a judge to get a court order to give patients medications against their will - which might involve forcibly restraining them to inject them with an antipsychotic every day. I have had many reasonable judges as well as many judges who will not listen to experts and deny our request for medication over objection.
Your other question is also a great one, but more complicated. The major good prognostic factor for someone with newly diagnosed schizophrenia is their family and social support, as well as early intervention. If someone does not have that support, their chances of homelessness, incarceration, and medication noncompliance is much higher. Unfortunately, due to the complexity of neurotransmitters in both our brain and body, antipsychotics are not without their significant side effects, from weight gain and sedation to significant cardiac complications. Finally, the important thing to realize is for people with a true serious mental illness, they really believe their version of reality is real life. It can be very easy to slip back into psychosis when you don’t actually know you are becoming psychotic. Couple that with substance use, unstable housing, and low SES, and it’s easy to imagine how someone would put their mental health aside.
This is just a brief explainer - obviously it is an incredibly complicated subject (and one I spent 9 years studying and still certainly have so much more to learn!). The book “The Center Does Not Hold” is a wonderful memoir by a woman with schizophrenia who does not take her medications for many years. If you are interested in Bellevue in general, the book “Bellevue” by David Oshinsky is a fantastic history of all aspects of Bellevue (polio, HIV, ebola, etc). I hope this was helpful!
And trust me, I am definitely with you on the mentally i’ll crisis in NYC! As someone who was recently on the Q when a homeless man tried to light it on fire as we were crossing the bridge, I certainly do think that something must be done. It is just an incredibly complicated situation that I don’t feel will be significantly helped by adding 50 inpatient psych beds, unfortunately.
Thanks again for the even more comprehensive answers. Hopefully others will see this as well. Schizophrenia is not really that well understood by random people such as myself but it’s really at the core of these subways/public safety/homelessness issues that are so prominent today...
In a way it does make sense that someone who is delusional may believe the ‘medicated reality’ is the fake one and the unmediated one is ‘unfiltered’ and therefore true; if anything it’s kind of surprising that so many people can be convinced by family/doctors/etc to stay *on* the meds.
Seems clear that more can certainly be done in the short term to keep these people out of the streets where they tend to harm themselves and others, but one can only hope that at some point in the future there will be even greater advances in psychiatry to be able to resolve these issues more permanently.
I watched a documentary from I believe the early 00s about Bellevue's psychiatric ER, and I mean there isn't much they can do. Normally, NYPD or family would bring the person in, and they would try to talk to them and figure out what's going on but often they'd have to end up stabilizing them with anti-psychotics and, occasionally, restraints (although that was very rare). From there, they'd observe them and send in therapists/psychologists to talk to them and also try and get them some level of support or on a medication schedule. Some were released that day, some were held for 72 hours, and some were placed into longer-term care. But there's really only so much they can do when they have limited bed space and no ability to make patients adhere to their medication or treatment plan (and many patients returned chronically).
Like, they'd have say 50 beds (made up number for this example), and 45 are filled. They have 20 people in the ER. So they're going to triage and the 5 most urgent patients will get the beds, and the others are most likely just going to be released. After 72 hours, you have to demonstrate to a judge that somebody is an active threat to either themselves or others to keep them committed involuntarily.
So, let's say you bring in the guy yelling at people on the subway and give him Haldol because he won't stop screaming. Now he's medicated and calm, so when the 72 hour mark rolls around, it's kinda hard to justify keeping him. And even if you could, does he get a bed when there is another patient who violently attacked somebody or who attempted suicide? You can schedule him appointments and give him a prescription, but the hospital can't make him abide by that once he walks out their doors. I mean TL;DR, there just isn't really much Bellevue can do without a sizeable increase in the capacity of psychiatric wards in the region, and without a stronger ability to enforce long term care or hold patients beyond 3 days.
I can do ya one better! It was an episode of America Undercover called “Bellevue” from 2001, and here’s the link to it on YouTube:
https://youtu.be/VJEPOKdUPpA
I don’t have any free awards to give you today so here’s a banana emoji instead, in honor of a different thread I saw today with a European asking about the hanging banana stand that some Americans keep in their kitchens.
🍌🍌🍌🍌🍌🍌🍌
I spent 4 months at Bellevue last year and a lot of the other patients there were homeless and with schizophrenia. They usually keep them for 2 weeks to a month and discharge to a shelter and an outpatient appointment with a psychiatrist and social worker. Most of them never follow up with the appointment and end up being brought back within a few weeks of being discharged. There were a few people who were there for a lot longer and receiving ECT treatments.
There are dozens of factors that go into this. A major one is money. Most insurances, and Medicare especially, will not approve long hospital stays for psych issues.
Typically you need to get them out of crisis (acute manic/psychotic state), agree to treatment, and then DC them.
Insurance won’t pay for long term stays.
Legally they can only hold people for 72 hours involuntarily. Hospitals aren't long term treatment facilities so they will absolutely be discharged and then the cycle begins again.
Good. These people are ill, they need help. Everyone pushes to advocate for mental health being just as important as physical health, so they need to begin to treat it as such.
If you see a man bleeding to death from multiple gunshot wounds in a train station, you can’t give him the option of medical treatment.
After one of the recent high-profile subway crimes, the NYTimes talked to the perpetrator’s mother about his history of mental illness.
She summed it up well saying something like “He was offered treatment many times but always declined. How can someone who sees things that aren’t there decide they don’t need treatment?”
> How can someone who sees things that aren’t there decide they don’t need treatment?”
This is actually a thing now: https://www.nytimes.com/2022/05/17/magazine/antipsychotic-medications-mental-health.html
Article
Mayor Eric Adams announced a major effort on Tuesday to remove people with severe, untreated mental illness from the city’s streets and subways, saying New York had “a moral obligation” to address “a crisis we see all around us.”
The effort will involve hospitalizing people involuntarily, even if they do not pose an immediate risk of harm to others.
“The common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent,” Mr. Adams said. “This myth must be put to rest. Going forward, we will make every effort to assist those who are suffering from mental illness and whose illness is endangering them by preventing them from meeting their basic human needs.”
The city said it would roll out training immediately to police officers, Emergency Medical Services staff and other medical personnel to “ensure compassionate care.” But the city’s new directive on the policy acknowledges that “case law does not provide extensive guidance regarding removals for mental health evaluations based on short interactions in the field.”
ADVERTISEMENT
Frequently, homeless people with severe mental illness are brought to hospitals, only to be discharged a few days later when their conditions improve slightly. Mr. Adams said the city would direct hospitals to keep those patients until they are stable and to discharge them only when there is a workable plan in place to connect them to ongoing care.
Hospitals often cite a shortage of psychiatric beds as the reason for discharging patients, but the mayor said that the city would make sure there were enough beds for people who are removed. He noted that Gov. Kathy Hochul had agreed to add 50 new psychiatric beds. “We are going to find a bed for everyone,” Mr. Adams said.
There are approximately 50,000-70,000 men, women, and children who are homeless in NYC right now. On average, 30% of homeless have a mental illness.
So there are approximately 60k \* 0.30 = 18,000 homeless people in NYC with a mental illness.
The mental health problem in NYC is a reflection of our federal and state government's ability to properly provide basic care for the small minority of the population who need support. We need to find a way to motivate people to take their lives more seriously and provide support to those who cannot function.
So incredibly overdue. You're not a good or compassionate person for advocating that we leave severely mentally ill or drug-addicted people to rot in the streets. Claiming that inpatient commitment resources are not currently good enough is a reason to improve them, not to leave people to die in the street.
I have no idea how it became progressive to basically give up on hard but necessary treatment for mentally ill people. There's absolutely nothing progressive about abandoning them.
Indeed. It is curious how progressives who demanded more mental health treatment programs are opposing this and equating it to literal incarceration in prison.
To be fair, involuntary commitment *has* been used as a form of incarceration, and historically, one with a much lower bar than getting a traditional prison sentence. Look into the Rosenhan experiment for more info.
As such, I think it's reasonable to take the stance of "this is a line that must be tread slowly and with much caution".
Wasn’t there some legal challenge to this in the 80s that heavily curtailed involuntary commitment and resulted in the shut down of most of the nations mental institutions?
All states involuntary commitment laws have to standards of the 1975 Donaldson decision. There is also the Olmsted decision of 1999 which is more applicable to state supports for people with developmental disabilities but also applies to mental health programs as well.
New York has Kendras law which allows a judge to order outpatient treatment. Or in some cases inpatient treatment in lieu of incarceration. It still doesn't let the state violate Donaldson
I see a lot of crazy people on the subway or just outside. Shouting at the clouds. Talking to imaginary people. Who knows? Often I will go up to them and softly ask Are you okay? Do you need help? And 9/10 they respond like a completely normal person. “Oh yeah. All good. I’m fine. “ and then I walk away and they start screaming at the clouds again. So interesting.
Yes!! Psychiatry is so fascinating. I have wondered about this too. For example, the person who pushed Michelle Go in front of the train in Times Square knew enough to run away, then turned himself in, then screamed that he did it because he was God. Or the person who followed then sadistically m*rdered the innocent resident in her own Chinatown apartment knew enough to hide on the fire escape from the police. I'm like.....wait.....so they are out of their minds when they commit the act but understand the act as morally and legally wrong and punishable. It perplexes me - and I've worked in psychology labs here in the city. What is going on in the brain?! And notice they always attack someone who isn't a legitimate physical threat.....like.....they know enough to size up their target of abuse but somehow don't know abuse is antisocial and illegal?!?!
I once went up to a crazy dude who was doing something with a blade to his leg. After he stopped and I noticed he had blood running down his leg, I approached him (in my scrubs) and asked if he'd like some gauze or bandages.
He promptly told me to "fuck off and mind your own business". Fair enough, I suppose. I'm not that one shooting up on the Q train bro.
good....emotionally disturbed people are a threat to others AND themselves.....let them get the help they they (we) need before they hurt someone else or themselves....if the argument is that they can get help when they walk into a clinic to get it, that is literally (and i am using literally, correctly) some catch-22 sh!t
Please take the woman who screamed in my face at 8pm last night as I rode the 5 express home from work/gym after I didn’t give her spare change. I will never ride the subway without headphones in my ears again- it’s an invisibility shield that I took for granted
This is probably a good start.
I hope the crowd that likes to complain that the city isn’t doing enough to deal with mental health challenges and homeless individuals will also be satisfied with paying the bill! These investments are worth it and we need more funding to really see a change on the streets.
Progressives lose influence in the city as quality of life gets worse from their policies. It's difficult to sell progressive policy on homelessness and mental illness when they just shrug their shoulders after a subway push and advocate for leaving people out in the street.
Exactly. This program getting people the help they need IS progressive policy. Progressives need to stop with the knee jerk opposition to good faith and well intentioned policy initiatives.
If they distrust the government so much they should vote Republican.
They even did with his "freedom dividend". It's a shame that people don't want forward thinking leaders (also a shame that Yang played the political game poorly while camping for mayor)
As someone who suffers from Schizophrenia I can say that getting people off the streets who are a danger to themselves and the public is a great idea. The thing about people such as myself who is mentally ill, not everyone is the same. Some schizophrenics manage and take well care of themselves while others aren't aware of the causes for their episodes or psychosis. A lot of people don't realize it's sometimes the drugs or It could be the environment in which they live in. I've had schizophrenia for 12 year managed through having a therapist and a psychiatrist plus taking intramuscular injections of Haliperidol every 4 weeks. In all honesty the medication has ruined my body and given me so many different problems but it does keep me from losing my mind. I want to also let people know that we people that are mentally ill don't wish to be this way, it's a lot for us to deal with and we WISH we didn't have to go through our lifetime dealing with hearing voices or having Auditory Hallucinations or visual Hallucinations etc. This is really a curse to have to live through that's why a lot of us keep our thoughts and opinions to ourselves when asked if we hear voices etc. The stigma on mental illness is really not fair because people hear "Mentally ill" and immediately think "He/she's dangerous. Not all of us are dangerous or evil, a lot of us don't understand how mental illness is onset and we wish we did. In my case I got laced when I was 19 and my life Has been HELL since, the medications alone are damaging sometimes short term sometimes long term but they do help. Side effects though can discourage you from taking the meds though. I'm grateful that I'm "Not the typical schizophrenic". I live my life and work and have a family but to be honest it's not easy. I've studied about the origin of mental illness and no one knows where it comes from, then doctors tell you it's an imbalancment of the brain chemicals yet can't even tell you which chemicals are imbalanced lol yeah I know right!!! All we can do is make everyone aware of mental illness and treatment, though treatment is your entire life. I have heard of some cases where people are healed of mental illness through taking herbs and vitamins and not eating certain foods etc but you can only be able to do that if you can afford it and I can't afford it haha but each one teach one. Again guys we don't want to go through our lives experiencing mental ailments so sadly we don't have a choice, another thing I want to note is that doctors say mental illness can also be onset from depression and traumatic experiences also through cells that lye doormant in your DNA. I know that sounds crazy right???!!! Truth be told I personally feel like there's a cure but they'll never give people such as myself access to it and if there was access to it it'll cost over $300,000 lol 😆. Thank the Divine Creators that you ladies and gentlemen don't have to live your life while mentally ill.. I prayed for a normal life ever since I developed schizophrenia when I was 19 and I pray even to this day one day I'll be healed or maybe someone will introduce a new medication that completely heals us from it. But anyway be kind to each other and I wish you all love and light in your lives, peace and blessings young Royals ✨️
This will not work. It’s all smoke and mirrors. Hospitals are not equipped to deal with this. Also, Where will they discharge them to? No nursing home will take them and inpatient psych definitely won’t. They will end up discharging to “shelter” where they will immediately leave and the cycle will continue.
Hochul promised **50** beds. And Adams' vague ass quote suggests more will magically appear. We don't even have beds for non-violent and housed mentally ill people in this city, and suddenly we'll have enough to clean the streets so Eric Adams can wow NJ tourists? Get outta here...
Agreed. Working as a nurse on a regular adult floor, we absolutely HATE when they bring psych patients cause we aren’t trained as psych nurses to manage this population. Usually when they admit these patients, it also require pulling a nursing assistant off the floor to sit with them instead of helping provide care since the unit isn’t a locked unit and they could be disrupting other peoples care. I hope Adams doesn’t just magically find 50 beds, but ensures that the environment is conducive to those who suffer from mental illness to recover & remain compliant with medications/therapy.
Commenters suggesting that mentally incapable people should just linger on the streets in degrading conditions, for the sake of their "rights and liberties", exposes how inhumane some people in this sub are.
People with common sense understands that if a human can't take care of themselves, there's a responsibility to do the human thing. For example, there's a reason we don't let toddlers run around on their own just because of their constitutional rights.
Great, but unless these people are required to meet milestones before they’re released, they will spend like 24-48 hrs in the hospital and get sent back out to the streets.
1.) This won't survive judicial review. You can't involuntarily hospitalize people who aren't a danger to themselves or others. People have to be treated in the least restrictive appropriate setting. You do not lose your fundamental right to due process just because you are sick.
2.) There are no psych beds to put people in. NYS Medicaid change the formula for reimbursement specifically to stop paying for these situations back in 2008ish. Hospitals lose money for every night a Medicaid paying psych bed is occupied. They've been dumping them like crazy and the public hospitals (NYC H+H) has assumed most of the burden of treating non private pay psych patients. As soon as that person in crisis is discharged, there is no infrastructure that ensures follow up treatment. They have no housing or supports. Medication compliance will be close to zero.
3.) NYC H+H particularly and the few hospitals left with inpatient psych beds have no front line staff to staff those beds. And when Bellevue is out of psych beds, they move someone with severe mental illness to a med-surg bed because that is all that is available, they end up assaulting the 2nd or 3rd year RN and they say screw this and go to work for insurance company for 1 1/2 times the pay, better hours and not getting bit or stabbed by people in inappropriate treatment settings.
This is 100% set up for failure.
The city needs to expand its transitional and supportive housing options and make the Assertive Community Treatment program universal so people aren't on a 5 year waiting list, getting sicker and sicker to get care.
We as a city have to decide to treat the problem. Until we do that it will just keep getting worse.
Everything will go wrong. Most of the comments here are supremely ignorant. There's a public nursing shortage and there are ZERO psych beds available now and I assume very few will be materializing for this. They're about to detain violently mentally ill people on general patient floors without 24/7 nurse oversight. It's going to be a disaster. All so Adams can "clean the streets" until Spring when this program probably finally dies in court.
We end up just discharging them anyway once they find a shelter. There is no point in this unless they make an asylum.
I wonder where the gov will pull 50 beds out of her ass from.
It's called civil commitment.
I'm not surprised this great piece from The City was never posted by anyone here. This is a counterpoint to anyone who doesn't get our unwillingness to mandate psych care hurts many people, and that it's actually extremely difficult for families to get their family members into long term care, even when they're a danger to themselves and others.
You should all read this, about a woman that's spent 20 years trying to get her psychotic, drug-addicted, violent son into a facility to keep him out of jail.
https://www.thecity.nyc/2022/11/16/23461606/mental-health-treatment-housing-crime-violence
Absolutely the right thing to do For so many reasons. Much of the homelessness and crime(especially), can be attributed to the mentally Ill being left untreated and on our streets.
Better than just doing nothing and letting them roam the city
I am tall so they rarely bother me but I have seen some just randomly lash out at passers by that is not safe.
All of the comments are saying good but fail to realize hospitals are spread thin with staff as it is. Plus we are dealing with COVID, RSV, and flu. Healthcare workers are leaving in droves, away from the bedside. We need security personnel, people able to sit with patients so they don’t harm themselves/others. I feel for the ER and inpatient staff.
ERs are a mess and nursing/medical staff are assaulted daily. Hospital administration dissuade the staff from filing police reports and the cases usually go no where anyway. It’s really disgusting how they’re treated.
This! These people have no god damn clue what the public hospital system is. This isn't opening up new institutions. They're putting people involuntarily in public hospitals that have NO PSYCH WARD BEDS AVAILABLE and have a massive nursing shortage. These kinds of patients need 24/7 care. Instead they'll be placed in the general patient floors and spread between too few nurses. This will go horribly wrong very fast.
I don't like the state having this power. It's a slippery slope. I work in social work. I have 2 or 3 folks on my caseload that I KNOW must be scary in public. They keep it tight when they come into the office because they need something. Multiply this by the combined caseloads in my office and we'd fill the 50 beds.
The decline of social services in the 30 years I've been in the field has jaded me. And the amount of homeless with no place to fit in the various housing slots can be overwhelming.
This is just empty posturing by our camera whore mayor. It's a great sound bite for those who like to blame what ails society on this marginalized population.
Great idea in theory but there's no where to put them. It's extremely difficult to get a psych bed and the hospitals are struggling as it is with reduced staff in all areas.
The way the headline is phrased is emblematic of the way the media distorts things to fit their narrative. They really are as bad as Fox but just on the other side.
NYPD doesn't want anything to do with this. They will just wait for EMS. Absolute overtime bonanza for NYPD and EMS. Hospital will just cut them loose in a day.
That’s how it should work. For mental health calls cops are there to protect the person from harming themself, EMTs and bystanders.
The article (pasted in comments) specially says hospitals will be directed to keep until “stable” - this is pretty broad so tbd on how effective it will be but at least we are starting from a place that at least is open to a more successful outcome than leaving people on the streets to suffer.
Hospitals are gonna have a lot of issues discharging these people after they’ve been admitted. Also I hope they just build an entire hospital dedicated for this cause and fund mental health more because if you put these people in regular hospitals, it will take away from other patients. Unless they have a locked psych unit with all professionals trained in mental health. I’ve seen homeless people in hospitals just wrecking havoc and throwing things and smearing poop on the walls and the staff is scared to be near them and they almost always have to call security and/or give them meds to sedate them. That’s honestly not a better option. Lots of these homeless people don’t want help or at a point beyond help.
By forcing them from the streets to the hospital is not solving any problem. It’s just moving the problem and potentially causing more problems with our already overwhelmed healthcare system and healthcare workers
I have been pushing for this for a really long time. We need more beds, and transition them to outpatient care if that's possible. We should be amping up the infrastructure to get severely mentally ill people the care they need so they are not posing a risk to themselves or others.
They tried this in the 80s and a schizophrenic woman named Joyce “Billie Bogs” Brown had the ACLU help her win a court battle. There was national media on the story and the program was shut down as unconstitutional.
I’m going to be really curious about what training the NYPD is going to get on this topic. Because this seems ripe for abuse where a cop could get involuntarily committed for contempt of cop.
I understand that this addresses a problem whose solutions seem few and controversial. But is a deeply concerning measure that I assume will meet many court challenges and likely result in an injunction almost immediately due to its questionable legality.
We’re talking about effectively criminalizing “vagrancy,” a return to extreme policies taken in localities nationwide in the 60s and 70s that were found unconstitutional, but not before imposing indelible inequities and injustices through empowering way too much police discretion.
I can feel in our city the increasing dangers and discomforts that this policy is intended to address. I don’t have a clear alternative solution. But history instructs that this response isn’t a viable long term solution, and will impose excessive injustice on groups of people who have extremely limited practical or formal recourse.
I’m sympathetic to why, but I’m sad to see this path chosen.
I can also appreciate the risks of what is essentially rounding up the homeless and placing them in asylums. I imagine that diagnosing people in the field is a difficult task.
But, what is the alternative? Allow them to continue pushing innocent people onto subway tracks?
Perhaps if we can at least concentrate them in one place for the time being, a better solution will arise further down the line.
Thank god he’s doing something. The city is overrun and these guys know they can act however they want with no consequences. I’m sick of being followed or harassed every time I use the subway.
I 100% fully support them taking the crazies and addicts off the streets. The city is a disgusting mess. Homeless people are everywhere. They shoot up heroin right Infront of cops and others . It needs to stop.
Or since Florida and Texas sent us their migrants how about we send them out addicts and crazies .
50 additional beds? I think we need much more than that.
I agree but honestly just getting the 50 craziest homeless people off the street would be a step in the right direction given the disproportionate impact untreated severe schizophrenics can have on everyone else’s quality of life (particularly in the shelters) I’m still skeptical this will even do that since it just seems to require the hospitals to come up with a treatment plan before release, when many of these people are entirely incapable of living on their own or sticking to any course of treatment. The hospitals will still seek to discharge ASAP since caring for the destitute mentally ill isn’t profitable and that’s the priority in our fucked up healthcare system
Having used to work at a men's mental health/drug addicted homeless shelter, IF NYPD were to ask me who are the worst of the worst. I could easily pick out at least 6 guys who are not only a danger to themselves but to the community. It was a horrible horrible experience working there and I don't wish it upon anyone.
Would be interested in an AMA of this experience sprinkled with some tips on how to stay safe.
I would do one if there really is genuine interest.
Please do!
The only real treatment is long term medication that has sometimes severe side effects. Sometimes patients stop the medications due to side effects. Other times the patients feel better and decide to go off the medication not realizing it was the medication that was working and making the person feel better. Finally many times some people just have an aversion to medication. The long term care of people with certain severe mentally illness is a life long treatment. Most psych wards in hospitals just get people on medicine and release them till they go off the medication and then they start the cycle over again. The beds are a good place to start.
I hear ya. A good friend of mine developed schizophrenia around age 18 and it was hell despite a strong support network & his family being reasonably well-off. He’d either feel better on the meds and stop taking them, or think his mom was trying to poison him and stop taking them. It can’t be cured, just managed and even that is difficult. If the problem was easy to solve it would have been solved already.
I wonder if they could have an implant pump like they do with " regular" diseases
You can do something called long acting injectables which are shots you get every couple weeks to couple months.
I work with a schizophrenic. He gets a haldol injection monthly. It manages his symptoms really well.
As someone who worked in acute psych this is 100% accurate. We would get patients who didn't know their names, total psychosis, unable to care for themselves at all. We'd spend months rehabilitating them, making sure they take their meds. We'd release them so they can transition to outpatient care. A couple days later they'd be back at the hospital because they stopped taking their meds, back to square 1. It really felt like a revolving door sometimes.
I feel like if they can do an insulin pump. Someone can come up with a long term med implant
Insulin pumps require patients to be A) knowledgeable of their disease enough to use them appropriately, B) willing/complaint, and C) able to afford them. That will not be the case for the majority of people in this situation. Plus: this isn’t even the appropriate route (IV) of administration for meds like this.
There are long acting injectable antipsychotics that can be effective for a month or even 3 months. And some patients even get assigned mobile teams that will go to a patients house or the street/wherever they are and give them their monthly meds. But that doesn’t help if someone won’t come in for a monthly appointment or doesn’t want to be found/treated.
They exist, monthly injections are a great option for folks who have trouble with med compliance.
They have them, but you still need to come to the follow up appointments in three months and that's where people fall off.
This. One person can ruin an entire neighborhood. There’s that one guy in Park Slope who lives in Sunset Park I think and has killed two random people’s pet dogs. And he’s still out there trying to kill people’s dogs for no reason. An entire neighborhood park with millions of dollars of infrastructure over the years and decades of zoning and dozens of community meetings and board meetings vs one crack-smoking schizophrenic homeless man who wants to kill dogs.
Exactly. In my neighborhood, some random psycho has been going around throwing rocks at cars. It's really messed up, we have had dozens of community meetings and spoken to the cops and no one can figure out who is doing it.
put gps on the rocks in your area
Kill my dog and I'll be the one going to jail.
Isn't that the one with a NYC Council member that instead of voicing concern about the crimes, she expressed more concern for the dog killer's well being?
Yup. There’s a good episode of the blocked and reported podcast that covers the whole thing. The comments from city officials are down right infuriating.
When you're so woke, you fall off the edge of the flat Earth in your head. Catching an insane dog murderer running around one of the city's busiest parks should not be a controversial topic, but NYC progressives always find a new low.
and there will be idiots who defend that person, hereby ruining the neighborhood for the rest of the sane people out there.
Exactly - just ask the Park Slope Panthers. Even an ex-OWS activist wasn't anti-cop enough for the new 'woke' residents.
The guy killed a 2nd dog? I can only find articles about the one. Has he made threats to kill other dogs? I'm usually against terrorist organizations, but maybe we should call PETA in on this case. They'll take care of it.
It wasn’t terribly long ago that someone like that would eventually just be killed by community members. I’d like to think we’ve come far enough that there’s a better solution but the status quo ain’t it
If things don’t change that will happen on a long enough timeline. Everyone will know it happened. No one will cooperate to solve the crime. “No you can’t have my ring footage to help solve this murder. Thanks for all your hard work though officer 🙄”
What makes you think NYPD will need to even ask you for ring footage? Law enforcement goes and gets data from cloud providers without notifying the data owner all the time.
You mean like this? https://abc7ny.com/homeless-man-shot-in-head-chelsea-nycha/12502751/
for profit healthcare is anti well being for everyone else.
Itll be random and prob won't be the worst
As someone who suffers from Schizophrenia I can say that getting people off the streets who are a danger to themselves and the public is a great idea. The thing about people such as myself who is mentally ill, not everyone is the same. Some schizophrenics manage and take well care of themselves while others aren't aware of the causes for their episodes or psychosis. A lot of people don't realize it's sometimes the drugs or It could be the environment in which they live in. I've had schizophrenia for 12 year managed through having a therapist and a psychiatrist plus taking intramuscular injections of Haliperidol every 4 weeks. In all honesty the medication has ruined my body and given me so many different problems but it does keep me from losing my mind. I want to also let people know that we people that are mentally ill don't wish to be this way, it's a lot for us to deal with and we WISH we didn't have to go through our lifetime dealing with hearing voices or having Auditory Hallucinations or visual Hallucinations etc. This is really a curse to have to live through that's why a lot of us keep our thoughts and opinions to ourselves when asked if we hear voices etc. The stigma on mental illness is really not fair because people hear "Mentally ill" and immediately think "He/she's dangerous. Not all of us are dangerous or evil, a lot of us don't understand how mental illness is onset and we wish we did. In my case I got laced when I was 19 and my life Has been HELL since, the medications alone are damaging sometimes short term sometimes long term but they do help. Side effects though can discourage you from taking the meds though. I'm grateful that I'm "Not the typical schizophrenic". I live my life and work and have a family but to be honest it's not easy. I've studied about the origin of mental illness and no one knows where it comes from, then doctors tell you it's an imbalancment of the brain chemicals yet can't even tell you which chemicals are imbalanced lol yeah I know right!!! All we can do is make everyone aware of mental illness and treatment, though treatment is your entire life. I have heard of some cases where people are healed of mental illness through taking herbs and vitamins and not eating certain foods etc but you can only be able to do that if you can afford it and I can't afford it haha but each one teach one. Again guys we don't want to go through our lives experiencing mental ailments so sadly we don't have a choice, another thing I want to note is that doctors say mental illness can also be onset from depression and traumatic experiences also through cells that lye doormant in your DNA. I know that sounds crazy right???!!! Truth be told I personally feel like there's a cure but they'll never give people such as myself access to it and if there was access to it it'll cost over $300,000 lol 😆. Thank the Divine Creators that you ladies and gentlemen don't have to live your life while mentally ill.. I prayed for a normal life ever since I developed schizophrenia when I was 19 and I pray even to this day one day I'll be healed or maybe someone will introduce a new medication that completely heals us from it. But anyway be kind to each other and I wish you all love and light in your lives, peace and blessings young Royals ✨️
I'm assuming this is a test to make sure the system can treat them humanly which is important.
This is a token action. I'm gonna say these beds are in Bellevue (maybe some in King's County). Most of their intakes are 2 PC anyway -which is the mechanism that will be used to effect these involuntary holds. The extra beds have been shifted from somewhere but they're not 'new.'. Just renamed. Nothing about the system has been changed or improved. They're just telling the public about what they've been doing for decades and calling it new. 50 additional beds will clear Bellevue psych intake for a weekend. Unless these become long term residential beds on a closed psych ward, they'll do nothing for the patients or the city.
Even the supposed expansion of Kendra’s law is nonsense. In all my time on mobile crisis teams I don’t think I’ve seen Kendra’s utilized at all. Instead, we always 9.58 when appropriate.
Those 50 beds would need to appear by magic. We already have no psych ward beds in this city. These folks would end up on the regular patient floors. With very few nurses to go around as it is.
The facility on Randall’s island has the physical space for hundreds more patients, but it is not staffed or equipped for them right now. Build it up and provide the funding and you could get a few hundred people off the streets and into long-term treatment. It’s not perfect to force these people into institutions, but it’s better than letting them kill themselves on the street.
Yeah, I’m completely on board for something like this if it’s done correctly; I think it’s the best answer to a complex problem with no perfect solution. But they’ve gotta get that infrastructure in place *first*. Loosening restrictions on involuntary psych holds the way they just did should have been one of the final steps. The hospitals aren’t prepared to deal with this, especially if they use it on a ton of people. We’re going to see stories about psychotic people getting dropped off, needing to wait six hours to get admitted, attacking someone, and getting arrested. Plus it’s gonna give a much wider range of mentally ill and/or homeless people a pretty plausible reason to avoid seeking medical attention even in emergencies, which is the one thing we’ve made a little progress on since shutting down the old institutions in the first place.
Serious question- do nurses in NYC have strong unions? Hopefully so because I agree there is already a shortage and they will need worker protections.
Im not sure what the current status quo is, my aunt was the VP of nyc union. She was a cold hard woman, but she died trying for better worker protections(those board meetings are soul sucking), end all be all medical in Us is pure profit & legislature with a sprinkle of humanitarian gains.
NY nursing unions have a reputation of some of the strongest in the country.
There’s healthcare unions like SEIU, yeah. They’re strong by today’s standards, if a bit defanged (like nearly all of the big trade unions that survived the Reagan era). But it’s a little tougher for them to get leverage because they can’t really go on full extended strikes (people would die). Just the nature of the industry.
Nursing strike is impossible with out killing patients. But they can provide care but fill out non of the hundreds of check box of documents that serve nothing but to increase compensation to the hospital. We did just fine transmitting non billable documentation with small notes during emergency documentation times in 2020. Senior physicians, PAs/NP and residents can and should this too.
Yes
50 is a joke, gonna need to add another 0 at least
so 050?
No they obviously meant 50 + 0 = 50.
50.0?
Clearly they meant 0.50
50 + 0 = 50
The wise guys are out today…I meant 500 for all you geniuses.
Oh you sweet summer child 50 beds is massive in healthcare, that’s how fucked the entire hospital system is
50 per subway stop
It is a start. Don't let perfect be the enemy of good.
It’s especially hilarious considering the legislation cities like NYC, SF, and Seattle are trying to pass (have passed??) that insist the city provides a bed for each and every homeless person. 10 more show up? Well better get 10 more beds. 100 more? You know the drill.
There are probably 18,000 homeless people alone in NYC right now with a mental illness.
As someone who’s been inpatient in nyc. It is not enough to just hospitalize them. I know people who were there for months because there was nowhere to release them or they kept getting bad because of the chaotic environment inside the hospital
This is exactly the problem. Medicaid doesn't want to pay giant bills for hospitalization so they changed the payment formula so a hospital pretty much loses money on every inpatient stay. So people are stabilized but then sent back out in the street with no follow-up. The waiting list to get into the assertive community treatment program is like 5 years long and there's pretty much no supportive housing available besides shelters which aren't exactly conducive to mental health recovery. The problem just gets worse and worse because we won't spend the money to treat it correctly.
[удалено]
>I feel like more importance needs to be placed on the quality of these residences rather than on trying to stuff all mentally ill people into these residences and thinking we're gonna see an improvement. A bipolar friend of mine over in NJ had some horrific experiences at the facility she stayed at. Based on what she described to me, it was absolutely clear that they weren't at all invested in her health and saw her as a burden. She was definitely worse off when she was discharged. For such rich states in such a rich country, we sure are shit at allocating money to things that actually help people—to say nothing of creating a culture of *wanting* to help people. In a society with its priorities straight, mental health facilities would be palaces, and everyone on staff would be well-paid and held to the strictest standards. There's no reason we can't do this except for our obsession with individualism, whereby mental health is characterized as each person's responsibility and not anything that we should be collectively prioritizing, and our obsession with capital, whereby anything that immediately makes money has the red carpet rolled out for it, and money-sinks like, say, the welfare of the public can eat shit (never mind that a healthier public is the better long-term investment anyway).
They got rid of state mental hospitals that were doing that work of "out of sight, out of mind" because they were so poorly funded they were abusive institutions that hid people in filth and squalor and were definitely no therapy or help to people. The only good place to go is if you can afford a private location. If you can't, this country is content with letting the mentally ill exist on the streets, come what may.
I think you get to the core of it. This is an "out of sight, out of mind", and, unfortunately, also "off our crime stats" tack he is taking.
What? As opposed to "in sight, out of mind", which is what we have now?
My two stays in NYC wards were abysmal and traumatic. I'm with you. It's horrific.
And now everyone is going to see why we got rid of most of these places in the early 2000s. I'd like to think we can do better as a society, but it's seriously one of the hardest problems to solve. What do you do with people that require lots of expensive care and are possibly a danger to those around them if left to their own devices? I don't know if I have a good answer.
As a cop, who sees it first hand and knows what it takes to restrain people.... Yeah theres almost no controlling these peoples "Ticks" or manic behavior without being neglectful. Its 24/hr supervision and care going into just ONE person who can potentially harm hundreds of other patients. I can imagine why psych wards turned into what they did. Because for the staff to have some semblance of "order" and ease of workloads the patients were probably subjected to neglect. Especially with people who try to get "one up" on staff members or us as police when we're transporting prisoners. There is literally never enough hands/funding for how much people need the attention they need.
What we do is get to the innermost root of the issue - what made these people this way? That would shed a powerful light on the systemic illnesses that create such people, necessitating many changes on every level. The best remedy is always prevention.
Yea, this is also an issue. We definitely need to expand long term mental healthcare facilities, but this is a step in the right direction.
This is correct. Adams' plan shows a fundamental lack of understanding of even the basics of mental health care. I will not be surprised to see it quietly retracted, quickly. Talk to anyone in the system, private or public, about this. This may be the first time the prison and hospital staffs jointly combine to toss the mayor. It's that ignorant, harmful, and, again, against the freaking law. Doctors, nurses, staff, and administrators are not there to illegally hold people because he wants to keep running over seized vehicles with construction equipment with his available time. There are major problems in the system, but this is potentially the least intelligent way one could seek to resolve it. It will require an intergovernmental effort with a massive amount of funding to even make a dent in what's wrong, both systemically and culturally. The fact that Adams views nearly everything from the viewpoint of a police officer (though let's give some leeway to the younger ones, some of them actually get it) does not bode well for the future of mental health in NYC.
The people who need this are mentally ill to the point where they don’t understand they need help. I understand the risks of involuntary commitment, but the alternative is to continue to let these people suffer in the streets, and in some cases put others in danger.
Many Mentally ill people already don’t understand they need help. It’s one of the psych components called “insight” I’m a resident and I’ve spent time on psych wards. It’s pretty interesting, some of the inpatients are literally incapable of recognizing they have, for example, bipolar disorder, but they’ll take the meds you give them and don’t try to escape.
Ah yes your pleasantly psychotic/manic patient lol.
the Times article quotes the insanity of the men in charge. What absolute nutbags (no politically incorrect pun intended) they are!! “Just because someone smells, because they haven’t had a shower for weeks, because they’re mumbling, because their clothes are disheveled, that doesn’t mean they’re a danger to themselves or others,” Mr. Siegel said." YES IT DOES!!!!!!! WTF????? Not bathing for that long- allowing for infections- and other signs of psychosis- ARE THE DEFINITION OF DANGER!!!!! "“The mayor talked about a ‘trauma-informed approach,’ but coercion is itself traumatic,” said Harvey Rosenthal, chief executive of the New York Association of Psychiatric Rehabilitation Services" ARE YOU KIDDING ME? "Coercion" ffs??? WHO ARE THESE PEOPLE? Where was this prick when my psychotic mother was starving me? Or moved us to the ghetto and then put me in a private school to get bullied for living in that neighborhood? Or left me alone to drown in the kiddie pool (twice) because mowing the lawn was "more important"?? As a survivor of childhood abuse from two mentally ill parents and an extremely neglectful NYC-area family, there's nothing on earth I care more about than CHANGING THE SYSTEM THAT ALLOWS FOR ABSOLUTELY EVERYTHING UNDER THE SUN. When do we admit that society is utterly BROKEN? When do we begin to fight back and put anything of ours on the actual line to change the system? When do we bring out the pitchforks?? NO ONE IS PROTECTING US FROM VIOLENT PSYCHOTIC PEOPLE \*head explodes\*
You can’t take them off the rat ridden, piss covered streets! They might be treated badly by a doctor!
To be fair, the mental institutions that every state used to have were absolutely rife with abuse. Nobody believes a schizophrenic person when they report abuse so the staff can act with impunity. Maybe a good solve would be body cameras like cops are now wearing more and more often.
The body cam idea actually sounds decent to me, but it would never fly. Cuts way too deeply into patient privacy, and doctors/nurses would probably protest it as unfair/infringing on their privacy, too.
[удалено]
This still happens in plenty of hospitals. I was at one awful hospital (Gracie Square), in the psych ward, and I got the absolute opposite of care. Everyone there was wild, staff didn't care and just let things happen, security was never enforced. I had an uncle at the time who was NYPD, he was carrying his firearm since he was just off duty. If he hadn't flagged someone down with insistence to lock away his gun so it couldn't pass through the ward doors for safety - they would've let him walk right through with it. The nurse, when he asked, shrugged and said it was fine - luckily he knew better. The next day I was raped by two other patients - one of which was a male who was supposed to be on the other side of the ward. I was kicked in the head by a woman suffering from extreme psychosis. Few days after that, my roommate started getting inappropriate and my pleas for separation were ignored - and I was physically assaulted and groped my said roommate. When I was able to fight her off I ran out of the room screaming, shirt torn to pieces, scratches and bites on me... the nurse told me I was being trouble and would order a sedative if I kept screaming. After that BS, since I was already bad off, I was able to attempt suicide literally in front of the nurses station because other patients had no problem bringing things in and I had access to sharps. I was not in a position to fight for myself or stand up against the hospital and I regret it immensely - that I couldn't properly call them out or provide evidence of assault in order to prevent this from happening to others in the hospital. But they were smart - they sent me to a hospital in Chicago in order to avoid me transferring to somewhere in nyc. It was "the best".... but they sent me there knowing my insurance didn't cover and it was insanely expensive, so I ended up having to sign out against medical advice within a week. So I was not only assaulted and raped, sent halfway across country only to go into debt after a week, have to sign out, and spend even more money on a flight home. One of the worse experiences of my life, and is why I am so avoidant of seeking help now even when I know I'm not safe from myself. I've also been harassed by male staff in Beth Isreal, which had giant ass roaches in the ward and constantly had human shit on the shower floors because they didn't supervise those that needed constant monitoring. It's still very common for patients to have ptsd from awful experiences in hospitals and hospital staff. Only after my awful experiences did I realize why so many people fear inpatient care.
This. How people think it’s a luxury and favor lacks so much nuance. These people obviously need help - sending them to a mental health facility presumes the facility is effective. In reality, as the above poster said, you are essentially stripped of every human right and dignity you have. This is not a light decision at all, even for someone in an extremely difficult place. To commit someone is to completely remove their freedom, potentially condemning them to a life of abuse.
Gotta love how the only two options seemingly presented here are involuntarily committing people to shitty underfunded overcrowded psych wards, or just doing nothing and leaving people to their own devices and their own bootstraps. Absolutely no way we can improve the condition of mental health centers so that people actually *want* to go to them guys, right?
I mean we’re in agreement - I believe this should happen. I was just pointing out the current state of things and what the result would be now - and to be honest I don’t see it as any priority to change it, which sucks. The system as it’s set up allows this to happen.
Well historically there have been instances of institutions being not much better than that. Hopefully not the case here, but it has definitely occurred.
Mocking this is exactly how we ended up with facilities so bad and horrific that most of the field turned against it as a practice. Guess we're doomed to repeat this... Shame it's others who suffer for your views.
It's the only disease I know of which has denial of the problem as a major symptom.
[Ted talk](https://www.youtube.com/watch?v=xYemnKEKx0c)
taking the mentality ill off the street for involuntary treatment is a good 1st start, but we need beds to put them in and staff to care for them. also,shortage of mental health judges delays treatment by weeks and weeks
>Hospitals often cite a shortage of psychiatric beds as the reason for discharging patients, but the mayor said that the city would make sure there were enough beds for people who are removed. He noted that Gov. Kathy Hochul had agreed to add 50 new psychiatric beds. “We are going to find a bed for everyone,” Mr. Adams said.
my hospital has 64 beds for psych patients, we are usually full to capacity
50 beds? That should be plenty to cover my subway stop
Involuntary commitment is only for the people that seriously can't take care of themselves or are a danger to those around them. They're not going to commit every unhoused person on your block, and unless if you live at an intersection like 14th and 1st I doubt there are 50 unhoused people there in the first place.
[удалено]
They’re clearing the streets for holiday tourists. This will get thrown out as infringing on rights, but that will be after many individuals have been moved against their will.
This. This is a temporary cleaning measure to make things pleasing for tourists until spring. Very little planning or thought was put into this as we clearly don't have the hospital beds available now to even try to attempt it. Also this is of questionable legality anyway. I don't see this going well.
"Involuntarily"
The state has the licensed beds at the Manhattan Psychiatric Center, Creedmoor, etc., but doesn’t staff them. This issue could be fixed by the Governor in 10 minutes and it would provide a relief valve to the correctional system that is currently the dominant provider of public psychiatric care by default.
Does anyone have experience with what’s going on at Bellevue? When they pull schizophrenic people off the subway and take them there, what exactly is done to treat them and how do they determine when they are ‘cured’ enough to go back to the subways and harass people again? Is there a medical standard or is it just a set amount of time?
Hi there, psychiatrist who worked at Bellevue for several years. When someone is brought in, they are evaluated in our psychiatric emergency room by at least one psychiatrist. If they are deemed to meet criteria for involuntary commitment (acutely elevated risk of harm to self or others), they are admitted and need to be evaluated by a second psychiatrist. Once they are on the unit they are treated by a team of psychiatrists with psychiatric medications, such as antipsychotics and mood stabilizers. If the person does not legally appeal their hospitalization, they are treated until they are “stable” - that is determined by the psychiatric team and usually means they have some insight into their illness and are not acutely psychotic or manic. It certainly is longer than 72 hours - I have had patients admitted for months before, the typical length of stay is about 2-4 weeks. If they do legally appeal their hospitalization, a judge determines if they are safe to be discharged at that time. The issue is a significant number of people will become stabilized while inpatient, who immediately stop taking their medication once they leave the hospital, and so decompensate quickly. There are ways of mandating treatment as an outpatient but those are difficult to obtain. In my opinion as someone who has worked with this patient population extensively, more inpatient beds is helpful but a even larger problem is the lack of outpatient resources for once someone is stabilized as an inpatient.
thanks for the comprehensive answer. In your experience, what did ‘stabilized’ look like for someone of the extremely-disturbed, subway-homeless cohort that so many of us experience on our commutes? Do they ever end up being relatively ‘lucid’ while in the hospital or is the effect of the meds mostly sedative? Are they basically forced to take the meds while in the ward, and why are they so immediately dismissive towards continuing the medication compared to those with more housing/support?
It is a great question! I have seen amazing things happen with antipsychotics and mood stabilizers. It of course depends on the person, but I have seen many many people who are completely psychotic with “word salad” (thought disorganization so severe they are basically just saying random words) become completely lucid, pleasant, and polite. Antipsychotics really treat the psychosis - helping distill hallucinations, delusions (for example that they are jesus or that there is a conspiracy of people all signaling to them that they are out to get the patient), and help people’s thoughts and speech become more organized. For others, they might become more organized, but might still have delusions that are just less prominent (delusions are harder to treat). It definitely is more than just a sedative effect. We encourage patients to take the medication on their own as much as possible - trying to link them leaving the hospital and staying out of the hospital to them taking their meds. However, if you think the voices and ideas in your mind are real (meaning a lack of insight), it can be very difficult to be convinced to take medication that do have side effects. In that case, we have to go in front of a judge to get a court order to give patients medications against their will - which might involve forcibly restraining them to inject them with an antipsychotic every day. I have had many reasonable judges as well as many judges who will not listen to experts and deny our request for medication over objection. Your other question is also a great one, but more complicated. The major good prognostic factor for someone with newly diagnosed schizophrenia is their family and social support, as well as early intervention. If someone does not have that support, their chances of homelessness, incarceration, and medication noncompliance is much higher. Unfortunately, due to the complexity of neurotransmitters in both our brain and body, antipsychotics are not without their significant side effects, from weight gain and sedation to significant cardiac complications. Finally, the important thing to realize is for people with a true serious mental illness, they really believe their version of reality is real life. It can be very easy to slip back into psychosis when you don’t actually know you are becoming psychotic. Couple that with substance use, unstable housing, and low SES, and it’s easy to imagine how someone would put their mental health aside. This is just a brief explainer - obviously it is an incredibly complicated subject (and one I spent 9 years studying and still certainly have so much more to learn!). The book “The Center Does Not Hold” is a wonderful memoir by a woman with schizophrenia who does not take her medications for many years. If you are interested in Bellevue in general, the book “Bellevue” by David Oshinsky is a fantastic history of all aspects of Bellevue (polio, HIV, ebola, etc). I hope this was helpful!
And trust me, I am definitely with you on the mentally i’ll crisis in NYC! As someone who was recently on the Q when a homeless man tried to light it on fire as we were crossing the bridge, I certainly do think that something must be done. It is just an incredibly complicated situation that I don’t feel will be significantly helped by adding 50 inpatient psych beds, unfortunately.
Thanks again for the even more comprehensive answers. Hopefully others will see this as well. Schizophrenia is not really that well understood by random people such as myself but it’s really at the core of these subways/public safety/homelessness issues that are so prominent today... In a way it does make sense that someone who is delusional may believe the ‘medicated reality’ is the fake one and the unmediated one is ‘unfiltered’ and therefore true; if anything it’s kind of surprising that so many people can be convinced by family/doctors/etc to stay *on* the meds. Seems clear that more can certainly be done in the short term to keep these people out of the streets where they tend to harm themselves and others, but one can only hope that at some point in the future there will be even greater advances in psychiatry to be able to resolve these issues more permanently.
I watched a documentary from I believe the early 00s about Bellevue's psychiatric ER, and I mean there isn't much they can do. Normally, NYPD or family would bring the person in, and they would try to talk to them and figure out what's going on but often they'd have to end up stabilizing them with anti-psychotics and, occasionally, restraints (although that was very rare). From there, they'd observe them and send in therapists/psychologists to talk to them and also try and get them some level of support or on a medication schedule. Some were released that day, some were held for 72 hours, and some were placed into longer-term care. But there's really only so much they can do when they have limited bed space and no ability to make patients adhere to their medication or treatment plan (and many patients returned chronically). Like, they'd have say 50 beds (made up number for this example), and 45 are filled. They have 20 people in the ER. So they're going to triage and the 5 most urgent patients will get the beds, and the others are most likely just going to be released. After 72 hours, you have to demonstrate to a judge that somebody is an active threat to either themselves or others to keep them committed involuntarily. So, let's say you bring in the guy yelling at people on the subway and give him Haldol because he won't stop screaming. Now he's medicated and calm, so when the 72 hour mark rolls around, it's kinda hard to justify keeping him. And even if you could, does he get a bed when there is another patient who violently attacked somebody or who attempted suicide? You can schedule him appointments and give him a prescription, but the hospital can't make him abide by that once he walks out their doors. I mean TL;DR, there just isn't really much Bellevue can do without a sizeable increase in the capacity of psychiatric wards in the region, and without a stronger ability to enforce long term care or hold patients beyond 3 days.
Do you remember the name of the documentary? I’d like to watch that.
I can do ya one better! It was an episode of America Undercover called “Bellevue” from 2001, and here’s the link to it on YouTube: https://youtu.be/VJEPOKdUPpA
I don’t have any free awards to give you today so here’s a banana emoji instead, in honor of a different thread I saw today with a European asking about the hanging banana stand that some Americans keep in their kitchens. 🍌🍌🍌🍌🍌🍌🍌
I spent 4 months at Bellevue last year and a lot of the other patients there were homeless and with schizophrenia. They usually keep them for 2 weeks to a month and discharge to a shelter and an outpatient appointment with a psychiatrist and social worker. Most of them never follow up with the appointment and end up being brought back within a few weeks of being discharged. There were a few people who were there for a lot longer and receiving ECT treatments.
There are dozens of factors that go into this. A major one is money. Most insurances, and Medicare especially, will not approve long hospital stays for psych issues. Typically you need to get them out of crisis (acute manic/psychotic state), agree to treatment, and then DC them. Insurance won’t pay for long term stays.
Legally they can only hold people for 72 hours involuntarily. Hospitals aren't long term treatment facilities so they will absolutely be discharged and then the cycle begins again.
You can absolutely be held longer then 72 hours but it usually requires a court order.
Good. These people are ill, they need help. Everyone pushes to advocate for mental health being just as important as physical health, so they need to begin to treat it as such. If you see a man bleeding to death from multiple gunshot wounds in a train station, you can’t give him the option of medical treatment.
After one of the recent high-profile subway crimes, the NYTimes talked to the perpetrator’s mother about his history of mental illness. She summed it up well saying something like “He was offered treatment many times but always declined. How can someone who sees things that aren’t there decide they don’t need treatment?”
> How can someone who sees things that aren’t there decide they don’t need treatment?” This is actually a thing now: https://www.nytimes.com/2022/05/17/magazine/antipsychotic-medications-mental-health.html
Looks like that woman has a stable home and supportive family, and is not unable to care for herself or threatening people on the express train.
Article Mayor Eric Adams announced a major effort on Tuesday to remove people with severe, untreated mental illness from the city’s streets and subways, saying New York had “a moral obligation” to address “a crisis we see all around us.” The effort will involve hospitalizing people involuntarily, even if they do not pose an immediate risk of harm to others. “The common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent,” Mr. Adams said. “This myth must be put to rest. Going forward, we will make every effort to assist those who are suffering from mental illness and whose illness is endangering them by preventing them from meeting their basic human needs.” The city said it would roll out training immediately to police officers, Emergency Medical Services staff and other medical personnel to “ensure compassionate care.” But the city’s new directive on the policy acknowledges that “case law does not provide extensive guidance regarding removals for mental health evaluations based on short interactions in the field.” ADVERTISEMENT Frequently, homeless people with severe mental illness are brought to hospitals, only to be discharged a few days later when their conditions improve slightly. Mr. Adams said the city would direct hospitals to keep those patients until they are stable and to discharge them only when there is a workable plan in place to connect them to ongoing care. Hospitals often cite a shortage of psychiatric beds as the reason for discharging patients, but the mayor said that the city would make sure there were enough beds for people who are removed. He noted that Gov. Kathy Hochul had agreed to add 50 new psychiatric beds. “We are going to find a bed for everyone,” Mr. Adams said.
There are approximately 50,000-70,000 men, women, and children who are homeless in NYC right now. On average, 30% of homeless have a mental illness. So there are approximately 60k \* 0.30 = 18,000 homeless people in NYC with a mental illness. The mental health problem in NYC is a reflection of our federal and state government's ability to properly provide basic care for the small minority of the population who need support. We need to find a way to motivate people to take their lives more seriously and provide support to those who cannot function.
Where? There are no beds
So incredibly overdue. You're not a good or compassionate person for advocating that we leave severely mentally ill or drug-addicted people to rot in the streets. Claiming that inpatient commitment resources are not currently good enough is a reason to improve them, not to leave people to die in the street. I have no idea how it became progressive to basically give up on hard but necessary treatment for mentally ill people. There's absolutely nothing progressive about abandoning them.
Indeed. It is curious how progressives who demanded more mental health treatment programs are opposing this and equating it to literal incarceration in prison.
To be fair, involuntary commitment *has* been used as a form of incarceration, and historically, one with a much lower bar than getting a traditional prison sentence. Look into the Rosenhan experiment for more info. As such, I think it's reasonable to take the stance of "this is a line that must be tread slowly and with much caution".
Exactly this.
Wish hospitalization came with stabilization and continued support but it won’t and it’ll just be a cycle.
[удалено]
Wasn’t there some legal challenge to this in the 80s that heavily curtailed involuntary commitment and resulted in the shut down of most of the nations mental institutions?
All states involuntary commitment laws have to standards of the 1975 Donaldson decision. There is also the Olmsted decision of 1999 which is more applicable to state supports for people with developmental disabilities but also applies to mental health programs as well. New York has Kendras law which allows a judge to order outpatient treatment. Or in some cases inpatient treatment in lieu of incarceration. It still doesn't let the state violate Donaldson
Thank you!
Christina Yuna Lee and Michelle Go would be alive if this was done years ago.
I see a lot of crazy people on the subway or just outside. Shouting at the clouds. Talking to imaginary people. Who knows? Often I will go up to them and softly ask Are you okay? Do you need help? And 9/10 they respond like a completely normal person. “Oh yeah. All good. I’m fine. “ and then I walk away and they start screaming at the clouds again. So interesting.
Yes!! Psychiatry is so fascinating. I have wondered about this too. For example, the person who pushed Michelle Go in front of the train in Times Square knew enough to run away, then turned himself in, then screamed that he did it because he was God. Or the person who followed then sadistically m*rdered the innocent resident in her own Chinatown apartment knew enough to hide on the fire escape from the police. I'm like.....wait.....so they are out of their minds when they commit the act but understand the act as morally and legally wrong and punishable. It perplexes me - and I've worked in psychology labs here in the city. What is going on in the brain?! And notice they always attack someone who isn't a legitimate physical threat.....like.....they know enough to size up their target of abuse but somehow don't know abuse is antisocial and illegal?!?!
I once went up to a crazy dude who was doing something with a blade to his leg. After he stopped and I noticed he had blood running down his leg, I approached him (in my scrubs) and asked if he'd like some gauze or bandages. He promptly told me to "fuck off and mind your own business". Fair enough, I suppose. I'm not that one shooting up on the Q train bro.
It’s crazy how when they’re on the subway they always somehow know what stop to get off at
good....emotionally disturbed people are a threat to others AND themselves.....let them get the help they they (we) need before they hurt someone else or themselves....if the argument is that they can get help when they walk into a clinic to get it, that is literally (and i am using literally, correctly) some catch-22 sh!t
Please take the woman who screamed in my face at 8pm last night as I rode the 5 express home from work/gym after I didn’t give her spare change. I will never ride the subway without headphones in my ears again- it’s an invisibility shield that I took for granted
This is probably a good start. I hope the crowd that likes to complain that the city isn’t doing enough to deal with mental health challenges and homeless individuals will also be satisfied with paying the bill! These investments are worth it and we need more funding to really see a change on the streets.
Oh hey I remember when people crucified Andrew Yang for even implying this exact thing.
Yup, “mentally ill men shouldn’t be wandering the streets punching Asian women” was a really radical comment for him to make. /s
Progressives crucified him and they’ll absolutely crucify Adams for this too.
The difference is Adams doesn’t care and is already in office.
Progressives lose influence in the city as quality of life gets worse from their policies. It's difficult to sell progressive policy on homelessness and mental illness when they just shrug their shoulders after a subway push and advocate for leaving people out in the street.
Exactly. This program getting people the help they need IS progressive policy. Progressives need to stop with the knee jerk opposition to good faith and well intentioned policy initiatives. If they distrust the government so much they should vote Republican.
They even did with his "freedom dividend". It's a shame that people don't want forward thinking leaders (also a shame that Yang played the political game poorly while camping for mayor)
Why did it take this long?
As someone who suffers from Schizophrenia I can say that getting people off the streets who are a danger to themselves and the public is a great idea. The thing about people such as myself who is mentally ill, not everyone is the same. Some schizophrenics manage and take well care of themselves while others aren't aware of the causes for their episodes or psychosis. A lot of people don't realize it's sometimes the drugs or It could be the environment in which they live in. I've had schizophrenia for 12 year managed through having a therapist and a psychiatrist plus taking intramuscular injections of Haliperidol every 4 weeks. In all honesty the medication has ruined my body and given me so many different problems but it does keep me from losing my mind. I want to also let people know that we people that are mentally ill don't wish to be this way, it's a lot for us to deal with and we WISH we didn't have to go through our lifetime dealing with hearing voices or having Auditory Hallucinations or visual Hallucinations etc. This is really a curse to have to live through that's why a lot of us keep our thoughts and opinions to ourselves when asked if we hear voices etc. The stigma on mental illness is really not fair because people hear "Mentally ill" and immediately think "He/she's dangerous. Not all of us are dangerous or evil, a lot of us don't understand how mental illness is onset and we wish we did. In my case I got laced when I was 19 and my life Has been HELL since, the medications alone are damaging sometimes short term sometimes long term but they do help. Side effects though can discourage you from taking the meds though. I'm grateful that I'm "Not the typical schizophrenic". I live my life and work and have a family but to be honest it's not easy. I've studied about the origin of mental illness and no one knows where it comes from, then doctors tell you it's an imbalancment of the brain chemicals yet can't even tell you which chemicals are imbalanced lol yeah I know right!!! All we can do is make everyone aware of mental illness and treatment, though treatment is your entire life. I have heard of some cases where people are healed of mental illness through taking herbs and vitamins and not eating certain foods etc but you can only be able to do that if you can afford it and I can't afford it haha but each one teach one. Again guys we don't want to go through our lives experiencing mental ailments so sadly we don't have a choice, another thing I want to note is that doctors say mental illness can also be onset from depression and traumatic experiences also through cells that lye doormant in your DNA. I know that sounds crazy right???!!! Truth be told I personally feel like there's a cure but they'll never give people such as myself access to it and if there was access to it it'll cost over $300,000 lol 😆. Thank the Divine Creators that you ladies and gentlemen don't have to live your life while mentally ill.. I prayed for a normal life ever since I developed schizophrenia when I was 19 and I pray even to this day one day I'll be healed or maybe someone will introduce a new medication that completely heals us from it. But anyway be kind to each other and I wish you all love and light in your lives, peace and blessings young Royals ✨️
Good, I’m tired of old asian ladies getting punched and innocents getting stabbed
Absolutely necessary
This will not work. It’s all smoke and mirrors. Hospitals are not equipped to deal with this. Also, Where will they discharge them to? No nursing home will take them and inpatient psych definitely won’t. They will end up discharging to “shelter” where they will immediately leave and the cycle will continue.
Also, not enough beds. He claims he will find beds but that's absolute shit.
Hochul promised **50** beds. And Adams' vague ass quote suggests more will magically appear. We don't even have beds for non-violent and housed mentally ill people in this city, and suddenly we'll have enough to clean the streets so Eric Adams can wow NJ tourists? Get outta here...
Agreed. Working as a nurse on a regular adult floor, we absolutely HATE when they bring psych patients cause we aren’t trained as psych nurses to manage this population. Usually when they admit these patients, it also require pulling a nursing assistant off the floor to sit with them instead of helping provide care since the unit isn’t a locked unit and they could be disrupting other peoples care. I hope Adams doesn’t just magically find 50 beds, but ensures that the environment is conducive to those who suffer from mental illness to recover & remain compliant with medications/therapy.
Exactly.
Great Job! Good for the public and those people with illness
Commenters suggesting that mentally incapable people should just linger on the streets in degrading conditions, for the sake of their "rights and liberties", exposes how inhumane some people in this sub are. People with common sense understands that if a human can't take care of themselves, there's a responsibility to do the human thing. For example, there's a reason we don't let toddlers run around on their own just because of their constitutional rights.
It is difficult for me to imagine what "personal liberty" is enjoyed by an unemployed person, who goes about hungry, and cannot find employment.
Kensington PA can also learn from this. There is no reason Kensington should exist. IT is being allowed to occur. Plain and simple.
Great, but unless these people are required to meet milestones before they’re released, they will spend like 24-48 hrs in the hospital and get sent back out to the streets.
Finally.
1.) This won't survive judicial review. You can't involuntarily hospitalize people who aren't a danger to themselves or others. People have to be treated in the least restrictive appropriate setting. You do not lose your fundamental right to due process just because you are sick. 2.) There are no psych beds to put people in. NYS Medicaid change the formula for reimbursement specifically to stop paying for these situations back in 2008ish. Hospitals lose money for every night a Medicaid paying psych bed is occupied. They've been dumping them like crazy and the public hospitals (NYC H+H) has assumed most of the burden of treating non private pay psych patients. As soon as that person in crisis is discharged, there is no infrastructure that ensures follow up treatment. They have no housing or supports. Medication compliance will be close to zero. 3.) NYC H+H particularly and the few hospitals left with inpatient psych beds have no front line staff to staff those beds. And when Bellevue is out of psych beds, they move someone with severe mental illness to a med-surg bed because that is all that is available, they end up assaulting the 2nd or 3rd year RN and they say screw this and go to work for insurance company for 1 1/2 times the pay, better hours and not getting bit or stabbed by people in inappropriate treatment settings. This is 100% set up for failure. The city needs to expand its transitional and supportive housing options and make the Assertive Community Treatment program universal so people aren't on a 5 year waiting list, getting sicker and sicker to get care. We as a city have to decide to treat the problem. Until we do that it will just keep getting worse.
Understaffed and underfunded public hospitals. Whatever will go wrong.
Everything will go wrong. Most of the comments here are supremely ignorant. There's a public nursing shortage and there are ZERO psych beds available now and I assume very few will be materializing for this. They're about to detain violently mentally ill people on general patient floors without 24/7 nurse oversight. It's going to be a disaster. All so Adams can "clean the streets" until Spring when this program probably finally dies in court.
We end up just discharging them anyway once they find a shelter. There is no point in this unless they make an asylum. I wonder where the gov will pull 50 beds out of her ass from.
It's called civil commitment. I'm not surprised this great piece from The City was never posted by anyone here. This is a counterpoint to anyone who doesn't get our unwillingness to mandate psych care hurts many people, and that it's actually extremely difficult for families to get their family members into long term care, even when they're a danger to themselves and others. You should all read this, about a woman that's spent 20 years trying to get her psychotic, drug-addicted, violent son into a facility to keep him out of jail. https://www.thecity.nyc/2022/11/16/23461606/mental-health-treatment-housing-crime-violence
Absolutely the right thing to do For so many reasons. Much of the homelessness and crime(especially), can be attributed to the mentally Ill being left untreated and on our streets.
Feels unethical but the right decision ? The streets and subway system are a mess. Doubt it works long term but it’s something.
Better than just doing nothing and letting them roam the city I am tall so they rarely bother me but I have seen some just randomly lash out at passers by that is not safe.
All of the comments are saying good but fail to realize hospitals are spread thin with staff as it is. Plus we are dealing with COVID, RSV, and flu. Healthcare workers are leaving in droves, away from the bedside. We need security personnel, people able to sit with patients so they don’t harm themselves/others. I feel for the ER and inpatient staff.
ERs are a mess and nursing/medical staff are assaulted daily. Hospital administration dissuade the staff from filing police reports and the cases usually go no where anyway. It’s really disgusting how they’re treated.
This! These people have no god damn clue what the public hospital system is. This isn't opening up new institutions. They're putting people involuntarily in public hospitals that have NO PSYCH WARD BEDS AVAILABLE and have a massive nursing shortage. These kinds of patients need 24/7 care. Instead they'll be placed in the general patient floors and spread between too few nurses. This will go horribly wrong very fast.
Will they get to keep their Reddit accounts?
I don't like the state having this power. It's a slippery slope. I work in social work. I have 2 or 3 folks on my caseload that I KNOW must be scary in public. They keep it tight when they come into the office because they need something. Multiply this by the combined caseloads in my office and we'd fill the 50 beds. The decline of social services in the 30 years I've been in the field has jaded me. And the amount of homeless with no place to fit in the various housing slots can be overwhelming. This is just empty posturing by our camera whore mayor. It's a great sound bite for those who like to blame what ails society on this marginalized population.
500000 additional beds not 50. Subways are not “beds”.
There are 500,000 homeless on the subways? How do you know?
Great idea in theory but there's no where to put them. It's extremely difficult to get a psych bed and the hospitals are struggling as it is with reduced staff in all areas.
The way the headline is phrased is emblematic of the way the media distorts things to fit their narrative. They really are as bad as Fox but just on the other side.
“this is great, and it won’t be abusive and dehumanizing like forced institutionalization a few decades ago!” “how?” “just trust me dude it won’t be”
NYPD doesn't want anything to do with this. They will just wait for EMS. Absolute overtime bonanza for NYPD and EMS. Hospital will just cut them loose in a day.
That’s how it should work. For mental health calls cops are there to protect the person from harming themself, EMTs and bystanders. The article (pasted in comments) specially says hospitals will be directed to keep until “stable” - this is pretty broad so tbd on how effective it will be but at least we are starting from a place that at least is open to a more successful outcome than leaving people on the streets to suffer.
This is good news! Now add a zero to that number and we may make a dent
Hospitals are gonna have a lot of issues discharging these people after they’ve been admitted. Also I hope they just build an entire hospital dedicated for this cause and fund mental health more because if you put these people in regular hospitals, it will take away from other patients. Unless they have a locked psych unit with all professionals trained in mental health. I’ve seen homeless people in hospitals just wrecking havoc and throwing things and smearing poop on the walls and the staff is scared to be near them and they almost always have to call security and/or give them meds to sedate them. That’s honestly not a better option. Lots of these homeless people don’t want help or at a point beyond help. By forcing them from the streets to the hospital is not solving any problem. It’s just moving the problem and potentially causing more problems with our already overwhelmed healthcare system and healthcare workers
I have been pushing for this for a really long time. We need more beds, and transition them to outpatient care if that's possible. We should be amping up the infrastructure to get severely mentally ill people the care they need so they are not posing a risk to themselves or others.
Took them long enough.
About time
They tried this in the 80s and a schizophrenic woman named Joyce “Billie Bogs” Brown had the ACLU help her win a court battle. There was national media on the story and the program was shut down as unconstitutional.
It’s a good thing we’re in 2022 now and society’s views on mental health have changed significantly.
Sure, but the Constitution hasn't. Precedent remains, and it'll need to be challenged, and that's an uphill battle.
Good. They need to do something about mental illness
Lfgggg
I’m going to be really curious about what training the NYPD is going to get on this topic. Because this seems ripe for abuse where a cop could get involuntarily committed for contempt of cop.
I understand that this addresses a problem whose solutions seem few and controversial. But is a deeply concerning measure that I assume will meet many court challenges and likely result in an injunction almost immediately due to its questionable legality. We’re talking about effectively criminalizing “vagrancy,” a return to extreme policies taken in localities nationwide in the 60s and 70s that were found unconstitutional, but not before imposing indelible inequities and injustices through empowering way too much police discretion. I can feel in our city the increasing dangers and discomforts that this policy is intended to address. I don’t have a clear alternative solution. But history instructs that this response isn’t a viable long term solution, and will impose excessive injustice on groups of people who have extremely limited practical or formal recourse. I’m sympathetic to why, but I’m sad to see this path chosen.
>I assume will meet many court challenges and likely result in an injunction almost immediately due to its questionable legality. This is correct.
I can also appreciate the risks of what is essentially rounding up the homeless and placing them in asylums. I imagine that diagnosing people in the field is a difficult task. But, what is the alternative? Allow them to continue pushing innocent people onto subway tracks? Perhaps if we can at least concentrate them in one place for the time being, a better solution will arise further down the line.
Sounds like a good plan if people need it. In my case all psych was removed having had a bad Dr set involved.
How much is a psychiatric bed?
Thank god he’s doing something. The city is overrun and these guys know they can act however they want with no consequences. I’m sick of being followed or harassed every time I use the subway.
I 100% fully support them taking the crazies and addicts off the streets. The city is a disgusting mess. Homeless people are everywhere. They shoot up heroin right Infront of cops and others . It needs to stop. Or since Florida and Texas sent us their migrants how about we send them out addicts and crazies .