What the Homeless Need: More Mental Health Care

Originally published in the New York Daily News.

In the 1980s, I was attacked by a homeless woman suffering from mental illness. She knocked me to the ground and injured my windpipe. She was in her 60s and had come to the upstate shelter where I worked after being kicked out of her home. A day before this incident, she had asked me to help her get admitted to the psychiatric unit at our local hospital.

We called the police: They have legal authority to transport people to hospitals when they have a mental illness and may present a danger to themselves or others. The officers interviewed the woman and transported her to the ER. Unfortunately, there were no vacant beds in the psych unit that night. Even though she wanted help, she was told to go back to the shelter.

Like many homeless people then and today, this woman faced an insurmountable obstacle blocking her access to treatment. After the attack, she apologized and said she hoped assaulting me, the safest person she could think of, might prove she needed hospital care. It took another week and the involvement of state officials to finally get her admitted.

She was fortunate. Many others in her situation never gain access to care at all. Instead, too often, their health declines to the point where they cannot even recognize their need for treatment. Many are charged with crimes, jailed and denied access to any form of treatment, much less housing and the rehabilitation services proven to help people with serious mental illnesses regain stability.

Things are not much better today than they were in the 1980s. Like every decade between then and now, violent incidents including some involving those with mental illnesses have prompted elected officials to tout ineffectual remedies, flooding the New York City transit system with police and outreach teams who are supposed to get people access to care.

This tactic has not solved the problem in the past, and it will not solve it now. Adding more police officers and outreach teams will not create adequate inpatient psychiatric bed capacity, more low-threshold stabilization shelters and safe havens, truly on-demand primary mental health care, or enough supportive housing for everyone who qualifies.

In 2019, the state estimated that 7.4% of the 363,026 adults accessing licensed mental health services in NYC were homeless. That’s more than 27,000 people. They were lucky enough to gain access to care in a notoriously inaccessible system, but sadly, thousands of New Yorkers are simply not able to access the mental health care they need. Of the 93,925 adults eligible in December of 2021 to receive enhanced mental health services in NYC under the state’s Medicaid managed care program for those with serious mental illnesses, only 2,179 — a meager 2.3% — actually received such care in the prior 12 months.

State inpatient psychiatric centers once housed roughly 93,000 New Yorkers, but today the number of state psychiatric hospital beds has dwindled to 2,330, of which about 1,000 are in NYC. Of the 3,763 acute and long-term psychiatric beds for adults in New York City, 72% are in acute care hospitals (68% statewide) that offer only short-term care (only a week on average). As of 2018, the city had nearly 950 fewer psychiatric inpatients on average each day than it had in 2012 (3,171 vs. 4,115).

The supply of inpatient beds has worsened during the pandemic as some psychiatric units were repurposed for COVID-19 care, and have not returned to psychiatric service.

To their credit, the city and state have built tens of thousands of units of permanent housing with onsite support services for homeless people living with mental illnesses or other disabilities. But there is only one such unit for every five people found eligible. Meanwhile, the demand keeps growing. The number of mental health calls to 911 in 2020 was 59% higher than it was in 2009, rising from 97,132 to 154,045 calls per year.

Every few years, a mayor or governor confidently announces a new plan to send police officers, sometimes teaming up with social workers, to “help” unsheltered homeless New Yorkers. They may succeed in pushing homeless individuals out of a few high-profile subway stations long enough to invite TV cameras, but the overall effort will fail because of the lack of access to housing, mental health care and low-threshold shelters.

Instead of repeating the mistakes of the past, Gov. Hochul and Mayor Adams must do the hard work of repairing our broken mental health system and put access to quality voluntary mental health care and permanent housing with support services front and center. If you want homeless people with mental illnesses to go someplace other than the streets and subway stations, offer them someplace better to go.

Nortz is deputy executive director for policy with Coalition for the Homeless.