In an essay for Vital City New York, Ford School professor David Thacher looks at the potential fall-out of Mayor Eric Adams’s recent order of forced psychiatric evaluation for people causing trouble on the streets and in the subway. He traces New York’s—and the country’s—struggle to provide support to people with mental health issues back to the movement in the early 1960’s to remove patients from state institutions and return them to the community. That movement was necessary and important, but it remains incomplete, and it left too many people struggling.
“Police became the first point of contact for many of the people that deinstitutionalization has failed, and they knew how badly those people were suffering and how poorly they were being served before almost anyone else,” he writes. “The continuing debates about how the police should understand their role in these encounters—including the debate prompted by Mayor Adams’s recent call for wider use of involuntary removals for psychiatric evaluation—is shaped by tacit assumptions about the purposes of deinstitutionalization and the reasons why it failed.”
The most common assumption is that deinstitutionalization failed because public policy did too little to deliver treatment effectively in the community. That task requires a broad community network of partners to help ensure that mentally ill people did not fall through the cracks, and also “the cooperation of the network of people who have regular contact with psychiatric patients… to help keep them engaged with their treatment and alert the treatment providers when difficulties arise. The police are a crucial part of that network because they are a major point of contact with people with serious mental illnesses when problems arise in the community and because they have the authority to enforce the system’s mandates when voluntary cooperation is not enough.”
Thacher says that Adams’s initiative aims to strengthen this role for the police, yet “police officers themselves are often uneasy with this role… they do not like being asked to do the mental health system’s dirty work.” He adds that police have good reason to be uneasy. “Many people have good reasons to refuse treatment. Medications may have intolerable side effects and fail to provide the relief they promised, and psychiatrists themselves recognize how difficult it is to find an appropriate treatment for many complex conditions; involuntary confinement to a psychiatric hospital is among the most traumatic and stigmatizing experiences anyone can undergo.”
The Mayor’s allies contend that he is showing compassion for people living in desperate circumstances. “But it is also naïve to believe that coercive interventions will only ensnare people who will actually benefit from them, and we should also have compassion for the people who have been profoundly harmed by psychiatric intervention or simply cannot be helped by it,” Thacher writes.
He calls for a rethinking of what deinstitutionalization was about and why it failed. “When American society shut down so many mental hospitals, the goal was not simply to move treatment into the community. The goal was also to build a more inclusive society, returning people who had been segregated in hospitals to their families and neighborhoods where they could live less constricted lives.”
“Focusing on the treatment needs of the individual with a serious mental illness is too narrow. The problem is that the environments where those individuals live lack the capacity to meet their needs. The police often know where these failures are concentrated, but we rarely encourage them to relay that knowledge to those who can demand change.”
Thacher concludes, “The needlessly narrow view of what deinstitutionalization was about that has dominated thought and action in this area has trapped us in a dilemma that pits freedom against care and blinds us to possibilities that can expand both.”
You can see the article here.