Involuntary hospitalization proves systemic failures

Since New York City Mayor Eric Adams’ November directive loosening requirements to allow involuntary hospitalization of unhoused persons who shows signs of mental distress, other cities and states have expressed interest in similar initiatives as means to reduce crime. While Mental Health America commends leaders for recognizing the need for mental health services for an often-overlooked segment of the population, involuntary hospitalization initiated by city workers, such as law enforcement, is not a solution; rather, it represents large failures of policy, practice, and community resources.

The apparent reason for allowing police and others to initiate involuntary commitment of unhoused people with perceived mental health needs is the widespread, but erroneous, belief that the rising crime rates in cities across the nation are largely attributable to people experiencing mental illness. While there have been some widely reported tragedies, studies have repeatedly proved that most acts of violence are not committed by people with mental illness. Instead, research shows that people with mental health conditions, including unhoused individuals and those in shelters, are often the victims of violent acts.

Mental Health America believes that this complex issue will not be solved with an oversimplified or overreaching policy.

The reality is that this policy approach, which unfairly targets unhoused people with mental illness, can cause more harm than help by putting them into cycles of hospitalization and creating unnecessary police interactions. This can be traumatizing, and even deadly, for people with mental illness, especially those in Black, Indigenous, and people of color communities and Disabled people. Being in distress and unhoused is not a crime. Yet, these interactions can mean transport in the back of a police car, usually in handcuffs, making the person feel like a criminal, not someone needing care.

Unhoused people with mental illness may want or need help. But involuntary commitment, let alone repeated commitments, is often a policy failure of years of unmet needs, a lack of housing, and unavailable supports. Many frame this and similar policies as the “compassionate” option, and we do not discount their empathy. However, investing in coercive approaches that still fail to address people’s comprehensive, sometimes even basic, needs is not compassionate.

Instead of relying on this last-resort method of “treating mental illness,” energy and resources would be better spent on upstream prevention and engaging resources, including housing, equitable community-based services, and peer and street outreach.

Unsurprisingly, experiencing homelessness exacerbates mental illness, which is why policymakers should first consider evidence-based supportive housing policies. When people have a safe place to live, they are highly likely to engage in treatment services that help them stay in the community.

Peer support specialists and street outreach should be prioritized over law enforcement encounters and coercive measures. These providers are specially trained individuals who share experiences, such as living with a mental health condition or have experienced homelessness. Peer support specialists offer connection, provide emotional support, teach skills, provide practical assistance, and introduce people to resources and other support communities.

The model of using peer support has proven to better engage people in resources that meet their mental health needs and lessen the number of readmissions and overall days an individual spends in the hospital. It also frees law enforcement officers for other duties, and empowers people experiencing homelessness to reclaim their lives.

Communities should expand successful programs like the Intensive and Sustained Engagement and Treatment (INSET) program offered by Mental Health Association of Westchester in New York, which successfully utilized peers to engage people with the same level of distress as those who are being involuntarily committed. Inpatient cost savings with INSET services range from hundreds of thousands of dollars to well over a million dollars.

Charlotte Ostman, CEO of MHA of Westchester, told us, “Our INSET staff first began to work with one young man when he was staying at a drop-in shelter, having been picked up by police numerous times for trespassing due to homelessness. He is now a resident of a shelter, awaiting permanent housing.” She went on to say that this individual had 33 ED visits in the year prior to INSET but has had only seven such visits. As a result of the program’s unique peer approach, he was able to voluntarily engaged in the resources that meet his needs.

In this unique time of bipartisan support for mental health services and attention to people that are homeless, we call for lawmakers and policymakers to address the underlying issue: the lack of access to mental health care and substance use treatment. Prevention, early intervention, a full continuum of community-based care, and safe places for people to live are the only real solutions.