On Nov. 29, New York City Mayor Eric Adams announced that city officials will begin involuntarily hospitalizing more houseless people to provide care to those deemed to be in “psychiatric crisis.” Adams claimed that training for the program, which will be deployed through the New York Police Department (NYPD) and the Department of Health and Mental Hygiene (DOHMH), will begin immediately. The program is part of Adams’ Psychiatric Crisis Care Legislative Agenda rollout, and it describes involuntary hospitalization and assisted or court-ordered outpatient care (known as AOT) as “essential components of a functional public mental health system.” The program has been met with widespread backlash across city agencies and online, with many decrying the program as aggressive and cruel. The plan is Adams’ latest effort to expand so-called “quality-of-life policing,” which is a euphemism for broken windows policing that became widely adopted by former Mayor Rudy Giuliani’s administration in the mid-90s. The program that terrorized New Yorkers continued under former Mayor Bill de Blasio and inspired similar forms of policing across the country. As Adams has said, the policy is specifically meant to target unsheltered people on subways and in encampments, preceded by the expansion of transit policing and citywide encampment sweeps. For some, the policy points toward a return to the era of asylums.
This policy deputizes health care workers and police to target unhoused people and sanctions these institutions to disappear people. A negative interaction with police inside the subway or outside your home, or a vindictive report from someone who knows you, could result in you being locked up and drugged without consent (which is nothing new).
While this plan is certainly cruel, only opposing this policy on the basis that it goes “too far” is insufficient and reactionary. We assert that the opposition to such state-sanctioned kidnapping must be grounded in abolitionist and disability justice principles, which reject the eugenicist, anti-Black, and sanist premise of disciplinary health care. Criticisms of this plan must recognize the historical continuity of carceral ableism, as expressed in New York’s existing forced commitment policies and the decades-long coordination between clinical institutions and law enforcement.
As people who have seen loved ones criminalized by these systems and who have been targeted by them ourselves, we fundamentally oppose the pathologization of problems produced by structural violence and worsened by systemic neglect. Rejecting the plan on the basis of these principles, and therefore rejecting the widespread normalization of carceral ableism—and the many intersecting ways that ableism and its harms are reproduced and exacerbated by police, prisons, confinement, punishment, and medical systems, which are often justified as providing necessary treatment—is key to developing organizing strategies that demand subsidized, consensual, trauma-informed, and non-carceral responses to people with mental health needs. It is critical that social workers, clinicians, psychiatric care providers, and medical professionals commit to non-compliance with this policy and others like it, even as we fight for the abolition of police and struggle against the eugenicist practices of the medical-industrial complex.
While involuntary hospitalization is not new to New York City, Adams’ plan does mark an alarming escalation and further proves that his priority is to incarcerate problems away. The plan would loosen admission criteria around risk and potential for harm, authorize a wider range of mental health providers to initiate admissions, and bypass HIPAA protections to share medical records with an AOT investigation (with or without a person’s consent). The mayor has already said that he will facilitate the “removal” of undesirables from public spaces and suggested that the replacement of Rikers Island penal colony with four borough-based jails is not enough. Crime panic, inflamed by copaganda, has been exploited by the NYPD and the current city administration to push for the expansion of Kendra’s Law, which allows courts to mandate the involuntary treatment of people believed to have stopped taking their prescribed medications. Yet it’s important to witness how the reformist and neoliberal tendencies of institutions, governments, and organizations attempting to tackle mass criminalization and incarceration bolster these machinations. Kendra’s Law was instituted not to protect mentally ill people or usher them into care, but to protect the larger community from mentally ill people who are perceived as dangers. The perception of who is or isn’t a threat isn’t neutral; it is dictated by the systems of oppression that shape our world. In New York, for example, court-ordered AOT commitments disproportionately affect Black and Hispanic people, whereas white people, who are 55% of the state’s population, comprise 31% of AOTs.
Adams’ plan is a grotesque co-optation of demands for “care not cages” and “defund the police” in a way that should provoke reflection for those making this demand. Such popular demands must hold the line around disability justice and the delinking of carceral technology and institutions with the provision of services. The carceral state cannot be allowed to further entrench itself via the myth of resource development. Adams is not alone in conflating “care” with hospitalization and pathologization, nor in attempting to redeem policing as capable of providing life-saving services. As abolitionist Nadja Eisenberg-Guyot writes, this return to a “rehabilitative” penal ideal is marked by jail and police reformers’ strategies to expand supposedly progressive programs—including community supervision, electronic monitoring, and diversion programs—while advocating for the construction of mental health jails. New York City’s administrators are attempting to position the city as a leader in such reforms, thereby expanding social control under the guise of expanded care and reduced criminal populations.
In response to demands for lasting reform and abolition of the prison-industrial complex (PIC), these trends in decarceration attempt to expand the site of control and surveillance from a penitentiary to the street, school, and clinic. They are also blatantly neoliberal in that they identify treatment as a solution for housing injustice and pandemic-driven precarity. In October 2022, The City broke the news that the number of vacant rent-stabilized apartments almost doubled from 2020 to 2021, even as the number of housing-insecure New Yorkers has also grown. Rather than recognizing his administration’s complicity in engineering houselessness by prioritizing real estate profiteers, Adams is attempting to manufacture consent for the criminalization of poverty, which has only worsened with the COVID-19 pandemic. The move is on-brand for a city and state which inherit the failures of the federal government during an enduring pandemic and of the rapidly deteriorated conditions inside jails and prisons, which were already unsurvivable. At the time of this article’s writing, city ICUs are overwhelmed, and The New York Times considers the community risk levels in four of NYC’s boroughs “high” based on hospitalizations and cases. Although the same departments do not serve mental health patients, this raises the question of what will happen when medical institutions are too overwhelmed to receive those being picked up on the street. Likely, they will be held at Rikers Island or another carceral facility.
Medicalization and subsequent criminalization of errant behavior, madness, and neurodivergence, alongside the detention of people considered to be a risk to public health, has deep roots in the U.S. settler-colonial history. This history includes the racialization of mental illness in ways that benefited slavers and settlers, including “drapetomania,” which characterized the desire for enslaved people to run away as mental illness, and made-up census data from 1840, which exaggerated mental illness among free Black people. It also includes the expanded use of institutionalization via mental asylums and poorhouses in the 20th century and, later, the development of for-profit pharmaceuticals, which have kept life-saving treatment out of reach for poor people. The histories of those forcibly institutionalized by the government show us the realities of such policies.
Research has also been clear that involuntary hospitalizations are ineffective. They increase the risk of suicide and lead to other kinds of harm and trauma that are well documented by the ongoing psychiatric survivor/ex-patients’ and Mad Pride movements. States with active and multiple peer respite centers—non-medical, peer-led community housing and resource centers for people in crisis to receive care—have reduced the need for psychiatric hospitalization by up to 70%. But when our carceral culture continues to invest in and rely on caging and confinement as the best or only solution, we severely lack the financial resources or capacity to scale up these non-coercive modes of care. And other research is clear: preventing people from living in poverty prevents mental health crises, like suicide. Since poverty significantly increases the likelihood of mental illness, interventions such as guaranteed income, free health care, access to housing, and other social interventions can be more supportive and sustainable than temporary medical interventions that don’t address the root of suffering and distress.
There is no argument to be made for the improvement of the policy when what already existed for mental health needs was life-threatening and untenable. Make no mistake; this is fascism. It is an attempt to manipulate us at a time when the carceral state is struggling to legitimize itself, and to mainstream or manufacture consent for the erasure and death of disabled people, as we have continued to see with the eugenic pandemic response.
People with the power to enforce this policy must commit to non-compliance in solidarity with disabled, mad, houseless, and incarcerated New Yorkers while others must continue to fight, creatively and determinedly, for housing and compensating everyone without means testing. One can only hope that the city’s elected officials will oppose this policy in response to the backlash, but we cannot wait on them—we must protect each other first.