A young man hangs out on a street corner in Midtown Manhattan every day outside the entrance of a big chain restaurant. He shadowboxes and talks to himself, and beneath him are poster boards with scrawled conspiracy theories. The restaurant’s manager worries the man could be scaring off customers and calls 911. Should the responding police officer remove the man to a hospital, forcing him if he refuses?
This is a scenario from the training materials for a new 24/7 hotline touted by Mayor Eric Adams and run by New York City’s public hospital system, which offers police officers on-demand guidance on whether to involuntarily hospitalize someone who appears mentally ill. Adams, a former transit cop, announced the hotline last November as part of a controversial directive to expand the police’s authority to perform the removals, pledging that the hotline would be staffed by psychiatrists, social workers, and clinicians who “will provide guidance to police officers who encounter individuals in psychiatric crisis”.
But the number of police officers who have consulted the hotline since it went live nearly half a year ago? Zero, according to public records disclosed last week by NYC Health + Hospitals, the municipal health system, and first reported by Politico.
Beth Haroules, an attorney who has led the New York Civil Liberties Union’s efforts to obtain records about Adams’s directive, calls the discovery “disturbing”. “Eric Adams promised that there was a clinical resource that would be made available to the NYPD, so that all of us would be assured that there would be no unlawful sweeps,” she tells the Guardian. “Then it turns out nobody’s using it. So Adams has misrepresented what the initiative is.”
Under longstanding New York state law, police may bring anyone to the hospital against their will if they appear to be mentally ill and pose a physical threat to themselves or others. But Adams’s directive significantly expanded the police’s authority to perform these involuntary removals. Now, any officer may force someone who appears mentally ill into a hospital if they simply appear to be unable to care for themselves – a condition that is defined broadly by the city’s new guidelines.
Documents about Adams’s directive obtained by NYCLU and shared with the Guardian reveal a police force that’s been given substantial latitude to decide who gets hospitalized, with little if any oversight from clinicians. According to training materials for police and health hotline staff, signs that could justify an involuntary hospitalization of someone with suspected mental illness include whether they look severely intoxicated, appear malnourished, or carry “firmly held beliefs not congruent with cultural ideas”.
Other factors that could qualify a person for forced hospitalization include their “willingness to engage in meaningful discussion” and whether they have “excessive fears of specific stimuli”. A person’s refusal of “voluntary treatment recommendations” could also be seen as evidence of diminished rational thought and grounds for hospitalization.
The documents also show the health hotline’s perfunctory role. A January agreement between NYPD and NYC Health + Hospitals states that any health provider would play a “non-clinical” role on the hotline, strictly limited to offering “support and psychoeducation to assist NYPD officers” in determining whether someone met the standard for involuntary hospitalization. The health provider would not be allowed to diagnose or offer treatment to the person over the call, and would only be allowed to speak to the police officer directly, not to the person in question or anyone else on the scene.
Haroules believes a clinician working for the hotline would in effect be asked to “lead the law enforcement person down a set of questions that would then result in, ‘Do you think this person is mentally ill and can’t take care of themselves?’ And the police person would say ‘Yes.’ And then the clinician would say, ‘My job here is done. Do what you have to do.’” The hotline’s real purpose, she suggests, “is to basically give the NYPD the courage to actually take somebody off the street”.
The lawyer says it’s unclear why so few people have used the hotline. One explanation is that police don’t feel the need to defer to clinicians. Another is that police simply don’t know about the hotline – which isn’t mentioned at all in the recent police training materials obtained by NYCLU.
A third explanation is that there are far fewer involuntary removals happening than advocates thought. A separate records request by NYCLU found that only 38 people had been involuntarily hospitalized at New York City public hospitals since Adams’s November directive, according to Health + Hospitals data provided to the civil rights organization. Haroules says that’s a surprisingly low number, given that city statistics show well over 100,000 emergency calls reporting “emotionally disturbed persons” a year. The lawyer has requested data from New York’s health department that would include private hospitals as well, and expects to receive it in a few weeks, she says.
In a statement, a spokesperson for Health + Hospitals called the hotline “just one additional tool for officers who may want to use it in the field” and said Adams’s administration was “doing everything it can help those with serious mental illness who may be a danger to themselves and our efforts are showing positive results”. Hospital staff who work for the hotline were doing other work and not just waiting for calls, the spokesperson added. (The mayor’s office and NYPD did not respond to emailed questions.)
For New York City’s mental health advocates, the discovery about the lack of calls to the hotline is just the latest example of an administration that has failed to protect its most vulnerable citizens. Adams has been “trying to solve a public health issue with a public safety response, and the whole thing feels misguided and misinformed”, says Matt Kudish, the executive director of the National Alliance on Mental Illness of New York City. Involuntary hospitalization should be an “absolute last resort”, he argues.
As for the hotline: “It’s not surprising to me that no one has called,” he says. “A more effective first response would be to finally invest in a comprehensive community mental health system in New York City.”
