On Wednesday, New York legislators considered mental-health-policy proposals in the state executive budget. Governor Kathy Hochul touted these reforms in last month’s State of the State address, responding to a string of violent incidents committed by people with untreated mental illness. One key proposal is to change the state’s legal standards for involuntarily hospitalizing the mentally ill; if enacted, it would protect both the mentally ill and everyday New Yorkers.
Hochul’s amendments would expand the criteria for involuntary commitment. New York’s mental-hygiene law currently lets hospitals retain mentally ill individuals whom clinicians deem an immediate danger to themselves or others. The governor reasonably wants to lower that standard, allowing for commitment when individuals are at “a substantial risk of physical harm” due to their “inability or refusal, as a result of their mental illness, to provide for their own essential needs.” This would better enable intervention before individuals decompensate to the point of homicidal or suicidal behavior.
Hochul also seeks to change the commitment process itself. Under her amendments, psychiatric nurse practitioners, in addition to clinicians, could recommend individuals for involuntary treatment. The governor also proposed requiring professionals to consider a patient’s relevant background, including his medical and behavioral history, when evaluating him for commitment.
Hochul’s proposal vindicates Mayor Eric Adams’s stalled mental-health-care efforts, delivering what he requested back in November 2022: more proactive treatment for the seriously mentally ill. So-styled mental-health advocates criticized Adams’s efforts to expand involuntary treatment, claiming they were intended “to lock more people away.” But as Paul S. Appelbaum, director of the Center for Law, Ethics and Psychiatry at Columbia University, wrote in response to Adams’s initiatives, “There’s an intrinsic humanitarian imperative not to stand by idly while these people waste away.”
Expanding commitment criteria is both morally defensible and popular. A 2022 poll by Spectrum News NY1/Siena College, for example, found that 89 percent of New Yorkers supported making it easier to hospitalize individuals who pose a danger to themselves or others.
Some state lawmakers were initially skeptical of Hochul’s proposed amendments, questioning whether New York had sufficient inpatient capacity to accommodate the change. “We are not ignoring the crisis, but if we have no place to direct people, it is a problem as well,” State Senate Majority Leader Andrea Stewart-Cousins told Politico reporters in January.
Stewart-Cousins isn’t entirely wrong. While Hochul added a few hundred beds to New York’s public psychiatric hospitals in the last two budget cycles (after her predecessor Andrew Cuomo’s devastating cuts), the state remains desperately short of them. Without a substantial increase in inpatient capacity, expanded involuntary commitment laws will have limited effects on patient stabilization and public disorder.
That doesn’t mean that the state shouldn’t enact Hochul’s changes. Thoughtful involuntary-commitment laws are a necessary, but not sufficient, condition for a better public mental-health system. To make a real impact on crime and disorder, though, New York also must add psychiatric beds and fund programs like assisted outpatient treatment that serve the seriously mentally ill. The governor’s budget does some of this, but doing more would make the Empire State safer—and more humane.
Photo by Newsday LLC/Getty Images