Serious Harms

On a spring evening this May, dozens of people filed into the seventy-two-year-old First Baptist Church on Brooklyn’s Eastern Parkway. They were there to hear from New York City’s mayoral candidates about their solutions to one of the city’s most pressing issues: mental illness, which in the public imagination is often conflated with street homelessness. In reality, mental illness isn’t always as public as a person talking to themselves on a Manhattan-bound C train, but pressure to keep it that way, hiding symptoms from family, friends and colleagues, can add to distress. In 2021, according to the most recent public health data, 1,660 New Yorkers died by suicide, and an estimated 41,500 New Yorkers attempted it. New Yorkers with serious mental illness (SMI) are receiving less treatment, according to a report released last year by the City’s Department of Health and Mental Hygiene, with 48 percent reporting that they had not received medication or therapy in the prior year. That increases to 70 percent when you factor in those without insurance.

Everyone has an opinion on the best way to treat the increasingly deployed acronym of SMI, but these opinions are often at odds with each other: lock everyone up or end forced treatment; bring back asylums or create social housing and increase community care. In recent years, New York politicians on both the state and city level have mostly taken the more restrictive road. As part of the latest state budget, passed earlier this month, Governor Kathy Hochul signed a law tightening compulsory treatment for people who appear mentally ill. At the city level, Mayor Eric Adams launched a similar directive in 2022, enabling the New York Police Department and other city agencies to take mentally ill people off the street based on appearance: between January and July of 2024, there was an average of nearly 130 involuntary removals per week. But involuntary treatment can undermine a patient’s independence, a crucial factor in their long-term health, and prevent them from actively seeking care when a court order expires. The actual data on how well it works is mixed.

Crown Heights, the majority-black neighborhood where First Baptist Church is located, has over the past decade vividly demonstrated the inadequacies of New York’s response to mental health crises. In 2018, police shot and killed thirty-four-year-old Saheed Vassell, a man with bipolar disorder who was experiencing mental distress. Officers had reported that Vassell was holding a gun, but it turned out to be a metal pipe. Three years later, twenty-six-year-old Eudes Pierre was shot on Eastern Parkway after brandishing a knife; he had called the police himself. I heard about the town hall from Eudes’s cousin, Sheina, whom I interviewed in 2023. In the years since, Sheina has devoted her energy to political lobbying and activism around mental illness. 

One of the people who organized the event at First Baptist was a woman named Christina Sparrock, founder of the New York Mental Health collective, a group focused on community-based solutions for mental illness. Sparrock, who lives with bipolar disorder, was assaulted by a former college friend exhibiting signs of mental illness in 2013. She called 911 and told the dispatcher that she had bipolar, thinking that was the right thing to do. “I thought once you mention child, senior, and mental health, you would get treated with more care,” she told me, a few weeks after the mayoral forum, “but instead of being treated as a person in crisis seeking help, I was labeled as an Emotionally Disturbed Person.” Emotionally Disturbed Person (EDP) is the code used by emergency services on mental health callouts. In the 2024 NYPD patrol guide, an EDP was defined as someone who appeared to be likely to cause serious injury to themselves or others, or under the influence of a mind-altering substance. The designation allows officers to take nonviolent people into custody. “The officers refused to take my complaint and blamed me even though I was the one assaulted,” Sparrock continued. “It left me feeling dismissed and further traumatized.” 

New York City has attempted to address the problems that arise when cops attend mental health calls by creating a program that instead sends out mental health workers called the Behavioral Health Emergency Assistance Response Division (B-HEARD) in 2021. However, the program has been underfunded throughout its four-year existence, resulting in limited implementation, says Sakeena Trice, a senior staff attorney at New York Lawyers for the Public Interest (NYLPI). B-HEARD currently operates in under half of New York’s seventy-eight police precincts, and while the number of teams has nearly doubled from 2023’s sixteen to today’s thirty-one, advocates argue the program still isn’t comprehensive enough. Additionally, B-HEARD only operates from 8 a.m. to 8 p.m., missing crucial nighttime hours, when crises tend to come to a head. “B-HEARD in its current guise does not work,” Trice says. “An overwhelming majority of mental health emergencies are going through police.”

At the First Baptist town hall, State Assemblymember Zohran Mamdani briefly highlighted B-HEARD, which currently operates at a yearly cost of $35 million. “We are going to increase funding to B-HEARD by 150 percent,” he promised. “Every New Yorker deserves to be safe, and every New Yorker must be protected.” Mamdani’s emphasis on safety was probably intentional. Mayor Adams was elected off the back of a city-wide crime panic, stoked largely by tabloid media, where a few-high profile, horrific murders by people with mental health issues dominated headlines in the aftermath of the early days of the Covid-19 pandemic. “We see this media blitz, especially in New York,” says Trice, “after the subway incidents, people are scared. That’s not something that we overlook.” The NYPLI tries to focus on facts not fear, educating people about the reality of serious mental illness.

This is no small task, as studies on the link between mental illness and violence tend to rely on reviews of other studies and are further complicated by a link between substance abuse and violence that can’t necessarily ignore the link between mental illness and substance abuse. While a 2011 study that analyzed more than 34,000 responses from the National Epidemiologic Survey on Alcohol and Related Conditions found that 2.9 percent of people with serious mental illness had committed a violent act, compared to 0.8 percent of people with no serious mental illness, multiple studies have found that people with mental illness are more likely to be victims of crime than perpetrators. Yet it is rare that the promise of safety is extended to people with serious mental illness themselves. This was made clear by the death of Jordan Neely, who had been in and out of mental health care before he was suffocated on the subway in 2023. His killer, Daniel Penny, was acquitted late last year and has since gone on to socialize with President Donald Trump and model in a New York fashion show.

Earlier this month, Governor Hochul announced that New York state would invest $16.5 million to expand Kendra’s Law. The law, also referred to as Assisted Outpatient Treatment (AOT), orders people with mental illness and a history of “lack of compliance” to take psychiatric medication and get other forms of mental health care. If those covered by the law do not comply, they can be taken to an emergency department for up to seventy-two hours before being admitted to inpatient psychiatric care or being discharged. Previously, AOT orders could only be renewed for thirty days after they expired, but the updated law has increased that deadline to six months. “They are allowing these orders to be renewed without necessarily going through the whole process and letting people be heard,” says Trice.

Hochul’s budget also changed the legal language used to force someone into a psychiatric ward. It used to be that someone could be subject to involuntary treatment only if they were likely to cause serious harm to themselves or another person. Now, under the updates to New York’s involuntary commitment statute, the criteria includes people who display “an inability or refusal, as a result of their mental illness, to provide for their own essential needs such as food, clothing, medical care, safety, or shelter.” In other words, a person can be hospitalized even if they are not suicidal or at risk of harming other people but simply because they appear to be hungry or unhoused. “These orders can dictate what medicine you take, what providers you see, where you live, who you live with,” says Trice. “People really feel like their mental illness, their homelessness, is being criminalized.”

Appearances are a subjective thing. Juliet, thirty-six, who asked to withhold her last name, says that there are days when she looks ragged, without make-up, her hair a mess and food on her clothes. Juliet lives with bipolar disorder; she had her first psychotic episode at fourteen. “I quit going to school, I was defiant . . . I had no care in the world, I did not care if I was failing out of high school.” But she turned her life around with the support of her parents, who enrolled her in a school that had a special program for students with serious mental illness and disabilities. “I truly thrived because these kids were kind of like me. I could survive that without feeling like I had the weight of the world on my shoulder,” she told me as we sat at a table in the Fountain House & Body shop and café in late May.

The store, which sells hand-crafted soaps and candles as well as coffee and food, had just soft-opened. A previous iteration opened in 2019 but shut down for a year in 2024 due to a lack of foot traffic. The new store is located near both the Fountain House art gallery, where artists with serious mental illness exhibit their work, and the Manhattan Fountain House, a clubhouse where members with serious mental illness can cook, learn, and get involved in advocacy. Juliet works in supported employment at the café and store, which also offers transitional employment for people with serious mental illness who are looking for workplace experience. People on transitional employment get paid the minimum wage, while those in supported employment get slightly more. It’s a good option for those who want to learn new skills, says Juliet, who has been on disability for a while, and it helps to pay the bills, but “not everybody who has mental illness should or wants to work.” That shouldn’t be considered a bad thing, she adds.

The job has helped her achieve a level of independence that she previously could not have imagined. “I’ve been, for the most part, self-sufficient on my own for two years. I have a job. I’m stable. I pay my own bills. I’m pretty proud of myself because I didn’t think that was possible ten years ago.” While Juliet was able to graduate from high school, she struggled with bipolar and anxiety throughout her twenties, until she found the right medication, a therapist, and a routine in New York. “When I first came to Fountain House, I was really hesitant because I was like, ‘I’m nothing like those people, those people talk to themselves, they’re shouting, they’re different’ . . . but there is such a broad spectrum of mental illness. That spectrum doesn’t get talked about enough. You are either a homeless guy on the street with no shoe, or you’ve got it together. There’s so much more in between that people aren’t aware of.” She takes pride in coming to work. “Not everybody can do that every day. And not everybody can do that at all.”

Fountain House, which received $9 million in funding from the New York state government in 2023 to help create a clubhouse in the Bronx, aims to engage with people with serious mental illness before they reach a crisis point, and the organization has a “reach out” team who will get in touch with members whom they haven’t heard from in a while. It’s one of many alternative models in mental health care that takes a more empathetic approach. Clubhouses work well for preventative care, providing a community and sense of purpose, and helping people access housing, but they aren’t an acute crisis service. To address that need, advocates like Sparrock envision a future where there are at least thirty respite centers across the city, offering an alternative to hospitalization, as well as an increased use of peer specialists, individuals with lived experience of mental illness who are in recovery, in crisis callouts. 

One example is Miele’s Respite in Queens, which is staffed by a mix of clinicians and peer specialists. It provides accommodation, support groups, activities, food, and care management for those voluntarily seeking psychiatric care, including referrals to community services. There’s also the Community Access Crisis Respite Center, which will open later this year, describes itself as the first of its kind in the city, guided by principles of peer support and self-determination. A post on the center’s website explains the difference: “Sometimes when you’re suicidal you need someone to listen to you, someone to understand you. It’s a cry for help—not necessarily a cry to be bound up inside the four walls of a hospital room.” These respite centers show that punitive models of care for people with serious mental illness are not always the right one, or the only option; it is possible to approach care for those in extreme distress from a place of dignity.

Joining Mamdani at the mental health town hall last month were New York City Comptroller Brad Lander, Scott Stringer, Whitney Tilson, Jim Walden, Michael Blake, and Selma Bartholomew. The frontrunner in June’s Democratic primary, former New York governor Andrew Cuomo, was noticeably absent, though he recently released a thirty-six-page report detailing his mental health platform. Cuomo’s plan is mostly focused on homeless people with serious mental illness. He wants to add more supportive housing units (although he stops short at an overhaul of the city’s rent-stabilization policy, which could prevent many people from becoming homeless in the first place), increase psychiatric beds, and improve access to preventative mental health services, which are outlined more vaguely. Cuomo’s plan also calls for increasing involuntary treatment, dictating that anyone discharged from Rikers Island or a public hospital be assessed for a  Kendra’s Law order. This focus might seem necessary if you read the New York Post (and Cuomo clearly does; his plan cites an op-ed from the tabloid), but there are roughly two thousand homeless people who live with a serious mental illness in the city—out of an estimated 858,000 New Yorkers with serious mental illness. In other words, the policy is mainly focused on 0.24 percent of the city’s most seriously mentally ill.

But the problem isn’t only the people whom these punitive models overlook. “The police response to mental health emergencies largely results in false arrests, injuries, and excessive force being used,” the NYLPI’s Trice says. In 2021, NYLPI filed a lawsuit against New York City, claiming that, among other things, the NYPD violates the Americans with Disabilities Act in responding to mental health callouts because sending a cop to a mental health crisis is not a reasonable accommodation. At the state level, the NYPLI has joined local mental health advocates in trying to get Daniel’s Law passed. The law, named after Daniel Prude who died in 2020 when a mental health callout resulted in police suffocating him with a mesh hood, stipulates that the state should create 24/7 crisis response units, with health care workers, peer workers, and EMTs instead of police.

Hochul’s latest budget included several recommendations made by the Daniel’s Law Task Force, including $2 million to create an entity that will help localities develop crisis response systems meant to replace law enforcement in “most cases,” and $6 million to go toward the relevant pilot programs. Even Cuomo seems to be aware of the limits of forced treatment: “Less than half of individuals subject to AOT orders in New York City are engaged in their services even six months into their initial twelve-month order,” his plan admits. But his solution, rather than rethinking the efficacy of involuntary treatment, is to double down on it.

Cuomo and the other candidates’ emphasis on safety in conversations about mental health policy makes sense: fear is a politically motivating factor, and many voters rank public safety, not helping people with mental illness achieve self-determination, at the top of their concerns. But whoever is elected mayor this year has a responsibility to protect all New Yorkers—and the opportunity to pursue bold policies that do more than sweep the most obviously suffering city residents under the rug and out of sight.