Thacher on coercion in mental health treatment

June 26, 2023

The death of Jordan Neely on a subway car in New York in May remains in the news, as a former marine, Daniel Penny, has been indicted for the chokehold that killed him. In the background, details of Neely’s mental illness has reignited a debate about how coercion is used to treat vulnerable people.

In an essay for Vital City, the Ford School’s David Thacher argues that Neely’s experience about society’s use of coercion in response to mental illness is that “policymakers and practitioners should be more restrained in the way they use it, not less.” 

“Although the overwhelming majority of people with serious mental illnesses are not violent, there are exceptions. How should violence that does seem to be connected to mental illness be addressed?,” he asks.

After a previous serious infraction, Neely had been enrolled in a treatment program for his schizophrenia and his drug addiction. But when he walked away from that program, no one went looking for him. Thacher admits that many people would see the horrible subway incident as evidence that the courts should have treated him more forcefully, he insists that it still “makes good sense to insist that coercion should always be viewed as a last resort — kept to an absolute minimum and used for limited and well-defined purposes.”

A more robust community-based care system, in which Neely had been a “partner” in the task of helping himself, could have prevented the tragic result. The current policy in New York City, to encourage coercion and treatment mandates, is forcing more people into the mental health system, “at a time when the city cannot even enforce the terms of a court-mandated treatment program on a man with multiple serious assaults.”

“By doing that, it guarantees that there will be more court-mandated treatment orders than the system can possibly enforce,” he writes.

He concludes, “Instead of trying to expand the reach of coercive psychiatry, cities like New York should focus more narrowly on cases like Neely’s where some degree of coercion is unequivocally justified…Ideally, coercion is used when it is the last resort to sustain a person’s engagement with treatment and support, still affording that person as much freedom as possible to choose the form the treatment will take. Doing that is a matter of carefully refining the kind of community-based program the court arranged for Jordan Neely, not giving up on it in favor of the asylum or jail.”

You can read the commentary here.