Homelessness and Mental Illness in NYC
Homelessness in New York City (NYC) has reached unprecedented levels, revealing deep cracks in the systems designed to support the city’s most vulnerable populations. Encounters with individuals experiencing homelessness and severe mental illness are increasingly common, sometimes leading to unsettling experiences, like the one I had recently – a homeless man screaming at me for twenty minutes on the subway. This moment of distress underscored a growing question in NYC: how do we help those who are clearly suffering from mental illness but refuse care?
Mayor Eric Adams’ administration has responded to this crisis with aggressive measures, including a push to involuntarily hospitalize individuals displaying severe mental health issues, even if they do not pose an immediate danger. But is forced hospitalization the right approach, or does it simply cycle people through short-term care, leaving the deeper issues unaddressed?
NYC’s Plan for Involuntary Hospitalization
Mayor Adams’ plan, announced in late 2022, authorizes first responders to hospitalize mentally ill homeless individuals who appear unable to care for themselves. This directive targets individuals who, through their actions or inactions, exhibit signs that they cannot meet their basic needs. The goal is to provide immediate care and prevent the deterioration of mental health conditions that often lead to public disturbances or personal harm.
While this policy may seem like a compassionate intervention on the surface, it has been met with significant pushback from civil liberties groups, mental health advocates, and even medical professionals. The core concern lies in the question of effectiveness.
Short-Term Fix, Long-Term Problem: Involuntary hospitalization can stabilize individuals temporarily, but once discharged, many return to the streets. The underlying mental health and housing instability that led to their initial crisis remain unaddressed.
Overburdened Hospitals: NYC’s psychiatric facilities are already overwhelmed. Brief stays cannot provide the long-term psychiatric and rehabilitative care necessary for individuals with severe mental illness and substance use disorders.
Erosion of Trust: Forcibly removing individuals from public spaces or subways can alienate them further, leading to distrust of the very systems meant to help them.
The Complex Intersection of Homelessness, Mental Health, and Addiction
Homelessness, mental illness, and substance use disorders are often interconnected, creating a web of challenges that no single intervention can untangle. In NYC, a significant portion of the homeless population experiences co-occurring disorders, where mental health conditions like schizophrenia or bipolar disorder are compounded by addiction to drugs or alcohol.
During brief hospitalizations, patients may receive medication and crisis stabilization, but long-term solutions – permanent housing, therapy, addiction treatment, and job training – remain elusive. This cycle perpetuates what can only be described as “revolving-door psychiatry,” where individuals are admitted, stabilized, and discharged, only to end up back on the streets.
Psychological Trauma and the Reality of the Streets
Living on the streets is inherently traumatic. Every day presents new risks, from violence to extreme weather, malnutrition, and lack of medical care. The psychological toll of this existence can exacerbate or even trigger mental health conditions, creating a feedback loop that is nearly impossible to escape without intervention.
However, trauma also fosters distrust. Many unhoused individuals avoid shelters or hospitals because of negative past experiences, fearing abuse, neglect, or simply being discharged with nowhere to go. Addressing this distrust is crucial to breaking the cycle of homelessness and mental illness.
What Can Be Done – Beyond Hospitalization
Expand Permanent Supportive Housing
Permanent supportive housing (PSH) has proven to be one of the most effective interventions for chronic homelessness. By combining long-term housing with wraparound services – including mental health care, substance abuse treatment, and job support – PSH addresses both housing instability and health conditions concurrently.
NYC has made strides in expanding PSH, but demand continues to outstrip supply. Increased investment in this model can help reduce the number of individuals living on the streets and subways.
Strengthen Outreach Programs
Street outreach programs, like those run by Breaking Ground or Project Renewal, engage with individuals directly where they are – under bridges, in subway tunnels, or in encampments. Building trust over time encourages people to accept care voluntarily, reducing the need for forced interventions. Expanding these outreach services can divert individuals from crisis before hospitalization becomes necessary.
Integrated Treatment for Dual Diagnoses
Mental illness and substance use disorders often go hand-in-hand. Integrated treatment approaches, which provide mental health and addiction care simultaneously, have better outcomes than treating these conditions separately. Expanding access to integrated care programs can significantly improve long-term recovery rates.
Crisis Stabilization Centers
Rather than relying on emergency rooms, NYC could invest in more crisis stabilization centers – non-hospital settings where individuals can receive immediate care without the trauma associated with traditional psychiatric wards. These centers provide short-term stabilization while connecting patients with ongoing community resources.
Diversion and Prevention Programs
Preventing homelessness is as important as addressing it once it occurs. Expanding eviction prevention programs, rental assistance, and financial aid for at-risk populations can reduce the influx of new individuals into the homeless system. Programs targeting youth, veterans, and survivors of domestic violence can address key populations vulnerable to housing instability.
The Ethical Question: Compassion or Coercion?
While the desire to remove mentally ill individuals from the streets comes from a place of compassion, coercion can have unintended consequences. Forced hospitalization raises ethical questions about autonomy, consent, and the role of the state in mental health care.
Ultimately, the most humane and effective approach blends compassion with structural reform. NYC must shift its focus from temporary fixes to sustainable, long-term solutions that honor the dignity of all individuals, regardless of their current housing or mental health status.
A Shared Responsibility
Homelessness and mental illness are not individual failings but systemic issues that require collective action. As residents of NYC, witnessing the suffering of our unhoused neighbors challenges us to advocate for policies that prioritize housing, health, and humanity. Mayor Adams’ policies may be one piece of the puzzle, but they cannot stand alone.
By addressing homelessness through housing-first approaches, integrated treatment, and community engagement, NYC can create a city where no one is left behind, and where compassion guides policy, not just expedience.
Max E. Guttman is the owner of Mindful Living LCSW, PLLC, a private mental health practice in Yonkers, New York.
