New York lost one of its most vocal public watchdogs last month, when mental health advocate (or “mental illness advocate,” as he would call himself) D.J. Jaffe passed away. However, Jaffe left behind ample record of what his views would be on yet another shocking act of violence arising from untreated mental illness on an Upper East Side subway platform.
He would be disgusted that in the city he lived in, pulling one’s own teeth out during psychosis was not enough to justify an involuntary hospitalization that might have prevented the crime.
In 1999, New York became a pioneer and model for the nation by developing and investing in Kendra’s Law, which authorizes court-supervised outpatient care for mentally ill individuals who struggle to adhere to prescribed treatment. New Yorkers should take immense pride in the good that has come from responding to tragedy with compassion and evidence-based solutions rooted in hope for those with severe mental illness.
But the state has been resting on its laurels for too long. The path to enrollment in a Kendra’s Law program starts at the door to a hospital, and for many, that door has been closed when it should not have been. Nobody qualifies for Kendra’s Law without a history of prior hospitalizations — and major roadblocks to admission remain unaddressed in state law. Until New York updates its overly restrictive standard for inpatient commitment, Kendra’s Law will reach only a small number of those who could benefit from these services.
New York is one of only five states whose laws do not explicitly recognize someone’s inability to meet basic survival needs due to untreated mental illness as grounds for hospitalization. Its place as an outlier among states in protecting its most vulnerable citizens flies in the face of all the effort and money put into Kendra’s Law –— or ThriveNYC, for that matter.
A person exhibiting mental illness in New York will be taken to an emergency room for evaluation after causing a domestic or public disturbance. The law allows this initial evaluation period to extend up to 72 hours. Anything beyond this requires a court order based on proof of the person’s dangerousness to self or others.
This is where the problem arises.
The crux of the issue is the failure of New York’s involuntary treatment criteria to define dangerousness in enough detail to make clear what is obvious to the average citizen: that a person who is unable to meet their basic survival needs due to untreated mental illness poses a danger to themselves. The state with the second-largest homeless population in the country is one of very few whose civil commitment laws do not protect people who, due to mental illness, can’t feed, clothe or shelter themselves.
At Treatment Advocacy Center, very often I hear from families in New York looking for help as they struggle to get treatment for loved ones who won’t volunteer to be admitted. They are often turned away under circumstances that would genuinely shock most New Yorkers.
Those in a position to make the call, including New York mental health professionals, tend to think of dangerousness purely in terms of imminent risk of either suicide or violence. Why? Blame the state’s commitment law, which lists “homicidal or other violent behavior” and “threats of or attempts at suicide or serious bodily harm” as the only concrete examples of conduct establishing a basis for commitment. While it also allows for the possible relevance of “other conduct demonstrating that the person is dangerous to himself,” it provides no guidance on what sort of conduct that might include.
The public mental health system in New York is a fragmented mess that focuses hundreds of millions of dollars on wellness while ignoring people too sick to come in from the cold. The disconnect is startling and should shock the conscience.
Now is the time for lawmakers to find a better path forward, for the mentally ill and the rest of us.
Dailey is advocacy director at the Treatment Advocacy Center.
