Democratic mayors lead course correction on psychiatric commitments

To sell the new policies to voters, as well as the mental health and homelessness advocates who have overwhelmingly panned them, lawmakers have employed a strikingly similar vocabulary to the one advocates used in the 1960s and 1970s to empty psychiatric institutions across the U.S. They speak of a moral responsibility to provide a compassionate response to inhumane conditions.

“We have to stop allowing individuals to essentially kill themselves on the street,” Los Angeles Mayor Karen Bass, a Democrat, said last year when she was campaigning.

“It is not acceptable for us to see someone who clearly needs help and walk past,” Adams, a retired NYPD captain, said during a November press conference announcing his policy directive. “If severe mental illness is causing someone to be unsheltered and a danger to themselves, we have a moral obligation to help them get the treatment and care they need.”

Still, the anti-crime undertones are clear.

“You can’t effectively have public safety without adequate mental health care — the two go hand-in-hand,” New York City Deputy Mayor for Public Safety Philip Banks III said in a statement accompanying Adams’ November announcement. “For too long, public safety personnel’s hands have been tied in getting those in need care before they hurt themselves or others,” said Banks, another former NYPD leader and close confidant of the mayor.

Critics of the new policies argue that people who are unhoused and living with serious mental illnesses are more likely to be the victims of a crime than the perpetrators. But murders and shootings surged during the worst of the pandemic, and New Yorkers became fixated on whether they could take the subway without feeling threatened, said Hank Sheinkopf, a veteran Democratic political consultant.

“There’s a relationship between chaos and crime in the eyes of voters,” Sheinkopf, whose clients included Bill Clinton and Michael Bloomberg, said in an interview. “The politics are governing the response, not great social policy.”

The policy shift — and the language around it — point to the rising influence of the Treatment Advocacy Center, an Arlington, Va.-based nonprofit started in 1998 to reform states’ civil commitment laws so people with severe mental health concerns receive treatment before they harm themselves or others.

Over 30 states have reformed their civil commitment laws with support from the group, according to its website. An ongoing $13.4 million federal grant program to help local mental health systems establish court-ordered outpatient treatment programs, which launched in 2016, has its roots in a Treatment Advocacy Center policy recommendation. And the group even has a three-person implementation department that has advised recipients on how to spend the grants.

The organization’s influence has been even more direct in New York City, where its former policy director, Brian Stettin, is the mayor’s senior adviser on severe mental illness. Stettin authored Adams’ recent policy directive.

Stettin said the administration recruited him after he penned a New York Daily News op-ed advising Adams to broadly interpret the state’s civil commitment laws as including “any individual whose untreated mental illness prevents them from meeting basic survival needs.” Previously, the law targeted people who posed a risk to themselves or others. Adams called him the day the piece ran, Stettin said.

“There’s a widespread view among some people who make policy in this area that recovery must always be self-directed and we have to wait for people to recognize they need treatment,” Stettin said in an interview.

“I think that if you go about mental health reform with that in mind — that it’s only a question of creating resources for people to take advantage of — you’re going to miss opportunities to help the most vulnerable people,” he added.