This past August, Mayor de Blasio announced the creation of NYC Safe, a $22 million initiative that promised an “unprecedented partnership between law enforcement and health care agencies” to help New Yorkers suffering from mental illness.
“Too many have literally lost their lives to untreated mental illness," de Blasio said in a statement. "NYC Safe will protect our city and save people from violence and suffering by making sure New Yorkers who need care will receive it, stick to it, and keep themselves and others safe."
The program is intended to help homeless people with mental illnesses and violent criminal records get connected to mental health resources, but at least two people on the list have been involuntarily hospitalized without the assent of psychiatrists—a possible violation of New York’s Mental Hygiene Law.
One patient was released from Bellevue Hospital’s psychiatric emergency room and sent back half an hour later because his shelter didn’t believe the opinion of the doctor who discharged him. After he was re-admitted to the hospital, he picked up an assault charge in a scuffle on the psychiatric ward and was then transferred to Rikers Island.
Another patient was committed to Bellevue and held involuntarily because the Mayor’s Office hadn’t cleared him for release, even after a psychiatrist evaluating him said it would be illegal to retain him against his will. Lawyers from the Bellevue office of the Mental Hygiene Legal Service, the state’s public defense agency for psychiatric patients, ultimately had to file a writ of habeas corpus to get him out.
Under NYC Safe, 73 people assessed to be mentally ill and at risk of violence have been referred by the Department of Homeless Services to the NYC Safe Hub, an office of City Hall that maintains the program’s participant list, widely called “the mayor’s high risk list.”
The goal of the program is “to connect those who are mentally ill and at high concern for violence with mental health care,” says Erin White, a spokesperson for the de Blasio administration.
There are two criteria for inclusion on the list. First, the person must have two incidents of “escalating aggression”—recorded instances of increasingly severe violent behavior—within six months, or have faced assault charges or a permanent order of protection.
Second, the Department of Homeless Services “must have attempted to intervene without success and be unable to manage the person’s care with existing resources.”
The program created five “co-response teams” combining NYPD officers and clinicians from the city’s Department of Health and Mental Hygiene to engage with people on the high risk list in emergency situations.
A source familiar with the operations of the teams says that part of their goal is to identify situations when someone on the list commits an offense directly related to mental illness, and in those cases to bring the person to a psychiatric hospital instead of taking them to jail.
Yet according to information from hearings at the internal courtroom at Bellevue Hospital, confirmed by several sources throughout the city’s mental health care community, the hospital has at times been required to admit people on the high risk list and instructed not to release them without coordinating with City Hall, whether they meet the legal standard for involuntary commitment or not. (The de Blasio administration denies this, and says that people in NYC Safe have no added discharge requirements.)
“The idea is to decriminalize mental illness by putting people in hospitals instead of taking them to Rikers,” says a doctor at one of the city’s psychiatric hospitals, who requested anonymity because they were not authorized by the hospital to speak to press. But if people are being held in hospitals without being found to require hospitalization, the doctor adds, “you’re throwing due process out the window. It’s back to the fifties”—when institutionalization of the mentally ill in the US hit its peak at more than 550,000 patients, and when legal standards for commitment still allowed non-dangerous people to be held involuntarily.
Mayor Bill de Blasio holds a roundtable message on Homeless/ Mental Health with DOC and First Lady Chirlane McCray in the Blue Room of City Hall, a few days before the announcement of NYC Safe (Demetrius Freeman / Mayoral Photography Office)
Dr. Jeremy Colley, director of Bellevue’s forensic psychiatry department, evaluated Paul (not his real name), a construction worker in his twenties, in the hospital’s psychiatric emergency room in September of 2015. He determined that Paul didn’t need to be there.
There are various standards for different kinds of involuntary commitment under Article 9 of New York’s Mental Hygiene Law, but in all cases the patient must be found dangerous to themselves or others.
“Even if [Paul is] dangerous, the evidence for which I find tenuous at best,” Dr. Colley wrote in his evaluation, “psychiatric hospitalization is not required.”
Dr. Colley discharged him, but as soon as Paul got to the shelter where he lives, officials there had him taken back to Bellevue. Paul is on the high risk list, so when he returned to the hospital, he was admitted in spite of Dr. Colley’s evaluation. According to testimony by another Bellevue psychiatrist during a hearing at the hospital to decide whether Paul should be medicated against his will, the doctors at Bellevue were instructed that Paul could only be discharged if Dr. Mary Anne Badaracco, head of psychiatry, cleared it with City Hall.
Paul never made it that far. One week after his admission to the hospital, he was charged with assault because of a struggle that happened when he was being restrained for an involuntary sedative injection. He was arrested, transferred to Bellevue’s prison psychiatric ward, and later moved to Rikers Island to wait for trial.
In another case from October, a patient was released from Bellevue by psychiatrists at the hospital, who said he didn’t require hospitalization. The next day, the police brought him back, saying that the doctors couldn’t release him without getting approval from City Hall.
Dr. Colley was involved again. He wrote that retaining the patient would be legally and clinically inappropriate. Still, the patient remained at the hospital.
Mental Hygiene Legal Service attorneys filed a writ of habeas corpus in the State Supreme Court, demanding that the hospital produce the patient and provide legal justification for holding him against his will. The court found in favor of the MHLS attorneys, and the patient was discharged.
Dr. Colley did not respond to requests to comment for this story—the details of his evaluations come from court testimony.
Evelyn Hernandez, a spokesperson for Bellevue Hospital, told Gothamist that she couldn’t discuss individual cases, but said that decisions about admitting and discharging patients are solely clinical and adhere to state law.
However, she also said that the purpose of NYC Safe is to connect people with social supports outside the hospital, and that the program “is designed to bring together those important agencies and supports before a patient is released.”
Many of the people Gothamist spoke to for this article emphasized that with some improvements, NYC Safe has the potential to fulfill its goal of connecting people in need of mental health care with critical resources.
The doctor at one of the city’s psychiatric hospitals noted that City Hall may even “have more complete information” about people on the high risk list than psychiatrists evaluating them in the emergency room do, since people may lie about their histories of hospitalization or risk factors for dangerousness.
Without the information gathered through NYC Safe, “no one is getting the big picture on some of these potentially dangerous people,” says the doctor. “I can’t even say they’re slipping through the cracks. They’re slipping through caverns.”
But questions about the program linger. Aside from hospitalization and the “co-response teams,” it’s unclear what resources the NYC Safe program gives its participants access to. Privacy issues have been raised, since the list is known to City Hall, the Department of Homeless Services, the Department of Health and Mental Hygiene, and the NYPD, and contains at least the information that people on it are mentally ill.
It’s also unclear how long people remain on the list or how they can get off it—City Hall acknowledged to Gothamist that they haven’t decided yet.
“I think it has a lot of potential,” says the doctor. “I’m sure there are kinks to be worked out.”
Ben Hattem is a journalist based in Brooklyn.
