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The Silent Sufferers

eye on the news

The Silent Sufferers

Many seriously mentally ill people never seek out treatment—so a new city proposal to expand voluntary services won’t help them. October 4, 2019
Health Care
New York
Public safety

Police shootings of emotionally disturbed persons are relatively rare, but disturb all New Yorkers. In a three-year period, police went on approximately 450,000 calls for emotionally disturbed persons (EDPs); most were resolved without incident, but 15 resulted in fatal shootings. This week, city-funded mental health associations gathered in support of Public Advocate Jumaane Williams’s well-intentioned report on how to improve police response to EDPs and those with serious mental illness.

Williams proposes expanding voluntary services. His call for more crisis-intervention teams to go into communities to help the seriously mentally ill is commendable. Right now, if someone calls the mayor’s highly touted NYC-WELL mental health line, they’re told to wait two days for a crisis team to show up. If they can’t wait, they’re told to call police—so increasing the number of crisis-intervention teams staffed by mental health practitioners will certainly cut down on the need for direct intervention from cops.

The problem: almost all the mentally ill whom the police tragically felt compelled to shoot in order to protect themselves or others either rejected voluntary treatment or were dropped from treatment by the mental health system. Voluntary interventions likely won’t help them. Deborah Danner, shot by police when she charged them with a bat in the Bronx; Saheed Vassell, shot when he pretended that a pipe he was holding was a gun and raised it; and Duane Jeune, shot when he rushed police with a knife—all had been taken by police to mental health services numerous times. Each time, they were stabilized, released, and permitted to go off treatment. In no case did any of them call a hotline and get voluntary services before acting out. Almost every time a seriously mentally ill person acts out violently, this sequence is invariable—the person was known to the mental health system but left untreated. Almost 40 percent of the seriously mentally ill in New York City receive no treatment, notwithstanding Mayor de Blasio’s multiyear, $850 million ThriveNYC mental health plan.

The most successful program for reducing police involvement with mentally ill individuals who reject services is Kendra’s Law, also known as assisted outpatient treatment (AOT). Under Kendra’s Law, judges—after observing due process—can commit seriously mentally ill people with a history of violence, incarceration or hospitalization to supervised treatment (often including medications), for up to one year, while they continue to live in the community. According to independent research, Kendra’s Law reduced arrests by 83 percent and incarceration by 87 percent for those under supervision. Another study found that individuals in AOT are four times less likely to commit violence than the untreated mentally ill. Yet the mayor’s recent management report shows that the city is cutting back, rather than expanding, the number of people under such supervision—and Williams omitted Kendra’s Law entirely from his proposal.

Williams should suggest expanding the number of people in Kendra’s Law. This can be accomplished through mandatory evaluation of seriously mentally ill individuals being discharged from jails and from hospitals after an involuntary commitment. The evaluation should ascertain what services they require to stay safe when released and to connect them with those services, including AOT, if necessary. This is the population most likely to return to jail or involuntary commitment without treatment. Almost all the tragedies that Williams enumerated could have been avoided if this step had been taken.

About 40 percent of the seriously mentally ill are so sick that they don’t know they’re sick, a condition called anosognosia. If we want to reduce homelessness and the arrest and incarceration of the seriously mentally ill, we must provide mental health services to these suffering people—over their objection, if necessary. Offering voluntary services will not solve the problem.

Photo: abhisheklegit/iStock

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