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Another Subway Tragedy

eye on the news

Another Subway Tragedy

The murder of Jacinto Suarez demonstrates the need for reforming how New York deals with serious mental illness. January 4, 2018
Health Care
New York

Governor Andrew Cuomo began his 2018 State of the State address 19 years to the day—and hour—that Kendra Webdale was pushed to her death in front of a subway train by Andrew Goldstein, a man with untreated serious mental illness. Before Cuomo finished his speech, something similar had happened again: mentally ill Andrew Cordero pushed Jacinto Suarez onto the subway tracks in Brooklyn. Suarez, too, died. Kendra’s death led to the adoption of Kendra’s Law, which empowers judges to mandate treatment for the mentally ill who are a danger to themselves or to the community. The death of Jacinto Suarez should lead to further reforms.  

While Cuomo didn’t mention Webdale or Kendra’s Law, he did talk about mental illness and the homeless. “Homelessness is on the rise in our cities and worse than ever before,” the governor said. “It pains me personally to acknowledge this reality.” As well it should: Cuomo’s unapologetic embrace of the long-standing bipartisan policy of closing state psychiatric hospitals is increasing both homelessness and incarceration.

The governor recounted his own history on the issue, recalling that he headed Mayor Dinkins’s homeless commission in 1992. I arranged for parents of the seriously mentally ill to testify before that commission. The parents wanted New York to adopt policies that would allow them to get care for their seriously mentally ill children before they became a danger to themselves or others. Cuomo rejected their pleas, siding with the mental health establishment, which has never been willing to take responsibility for the most seriously ill. As Cuomo wrote in the commission’s report, “The Commission considered and rejected a lowering of the standard for involuntary institutionalization as . . .  inappropriate and unnecessary.” He noted that sick people could be sent to state hospitals “for months” to be stabilized. But during his tenure as governor, he has closed state psychiatric hospitals, effectively taking that option off the table.

The governor spoke eloquently about the plight of people incapable of taking care of themselves. “While we aggressively protect an individual’s civil liberties, we believe in helping people in need.” Leaving the sick to “fend for themselves is not progressive, charitable or ethical or legal.” Cuomo emphasized the need for more outreach, proclaiming that “some jurisdictions say case law prevents them from helping mentally ill street homeless. If that is their excuse, they should tell us what law stops them from helping sick homeless people and we will change the law this session.” But the governor is being disingenuous: the changes needed are the same ones that Democrats have refused to support in the past, and that he blocked when he headed the mayor’s homeless commission. These proposals have been made multiple times in recent years by State Senator Catharine Young, and more recently were included in the campaign platform of Assembly Member Nicole Malliotakis when she ran for mayor of New York City.

From a practical standpoint, New York law requires someone to become a “danger to self or others” before he or she can be involuntarily committed. But laws should prevent violence, not require it. New York is one of the few states without an adequate “need for treatment” or “grave disability” standard. A second problem is that in New York, even after someone is found to be a “danger to self or others” and involuntarily committed, he or she can still refuse treatment; a second hearing is required to overcome that objection. New York must pass a law requiring the involuntary-treatment hearing to be held at the same time as the involuntary-commitment hearing.  

Kendra’s Law lets courts order the most seriously mentally ill who have already accumulated multiple incidents of violence, arrest, hospitalization, or homelessness to stay, for up to one year, in mandated and monitored treatment while they continue to live in the community. This arrangement is less restrictive and more humane than inpatient commitment or incarceration. It has been proven to reduce homelessness, arrest, and incarceration, and it is more cost-efficient. But it is impossible for community providers to ramp up their programs when the governor keeps putting a five-year sunset on the bill. He should insist that it be made permanent this year.

Cuomo called for more agency outreach, but he didn’t mention outreach to mentally ill prisoners, who are being discharged from jails and prisons, and involuntarily committed patients, who are being discharged from hospitals. These are the most likely people to become homeless or incarcerated. Mentally ill Andrew Cordero had been arrested three times since September, and police had been called to his home multiple times as a result of his bipolar disorder.  

The New York State Office of Mental Health (OMH) must focus on the seriously mentally ill. While Governor Cuomo identified the homeless seriously mentally ill as a priority, his mental health commissioner recently touted the release of a new OMH-funded coloring book. Andrew Goldstein and Andrew Cordero did not need coloring books—they needed treatment. OMH should stop funding programs that don’t reduce homelessness, arrest, incarceration, and needless hospitalization, and transfer funds to the programs that do. OMH should also set up a hotline that families and the public could call to report someone with mental illness who may need Kendra’s Law to stay safe. And OMH should end the practice of giving funding and veto power to nonprofit trade associations that lobby to close more hospitals, in contravention of Kendra’s Law.

Governor Cuomo knows how to deliver a good speech. But until the governor puts some meat and money behind his proposals for the seriously mentally ill, they are only words.

Photo by sdominick/iStock

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