Down-and-out New Yorkers suffering psychiatric issues so severe they can’t care for themselves can be whisked into treatment easier under a long-awaited deal to tackle the Big Apple’s mental health crisis.
Involuntary commitment standards – the rules by which severely mentally ill people can be forced into psychiatric care against their will – will be expanded and loosened under an Albany budget agreement finally revealed Wednesday.
Gov. Kathy Hochul and state lawmakers reached the deal over months of backroom talks prompted in part by violence in the subways, random attacks on the city’s streets and Mayor Eric Adams using his bully pulpit to push for changes to involuntary commitment rules.
Leaders such as Adams grew frustrated that the law previously only allowed people to be involuntarily committed if they showed a substantial risk to physically harm themselves or others.
The final deal reached by Hochul and lawmakers would expand it to people who show a substantial risk of physical harm to themselves because to an “inability or refusal, as a result of their mental illness, to provide for their own essential needs such as food, clothing, necessary medical care, personal safety, or shelter.”
Additionally, someone may now be committed after sign-off from an examining physician and a nurse practitioner.
Commitment used to require the sign-off of two examining physicians.
Those practitioners would have three days after someone is brought to the hospital to decide whether he or she should be committed.
They would be required to make attempts to contact someone’s medical providers and any designated points of contact prior to ordering commitment.
Hochul faced resistance on the proposal from both houses of the state legislature as well as mental health advocacy groups.
The critics argued that strengthening involuntary commitment measures alone wouldn’t solve the issue and that the changes needed to be accompanied by supporting other aspects of the mental health care system like follow-up care planning and supportive housing to keep people from slipping through the cracks.
As a result, the final deal includes additional requirements for psychiatric centers and local social services agencies to coordinate more effective discharge planning for follow-ups once someone is released from care.
This includes:
Providing a summary of the discharge plan to any of the person’s medical providers.
Making a follow-up appointment with a provider for the patient within a week or “as soon as possible thereafter.”
Giving the discharge plan to a “post-discharge care manager” in the case of an individual with complex needs.
The deal would also create a new behavioral health crisis technical assistance center at the state level to further develop protocols and best practices around involuntary commitment and deliver annual reports on the measure’s effectiveness.
Mental health groups had also been pushing, as an alternative to Hochul’s proposal, forcing the state to conduct critical incident reviews after mentally ill people commit particularly egregious acts.
Language included in the budget bill separate from the section on involuntary commitment would require the state to complete at least one critical incident review on a situation involving a fatality at least once a quarter.
But the toothless provision once again lets state mental health officials off the hook by stipulating that the findings of those panels can’t be released publicly.
